The Orissa Value Added Tax Rules, 2005 FORMS
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FORM VAT - 320

APPLICATION FOR REFUND OF TAX (SUBSTITUTED BY FORM 320A W.E.F. 03-03-2014)

[Refer sub-rule (1) of rule 66]

01. OFFICE ADDRESS

YYYY

TIN

03. NAME AND ADDRESS OF THE DEALER

(Use separate sheet if the space provided is found inadequate)

04. Tax Period (s)

D D

M M

Y Y Y Y

From

D D

M M

Y Y Y Y

05. Value of goods exported out of the territory of India

Rs._______________________

06. Amount of input tax due for refund as result of export out of the territory of India

Rs_______________________

07. Amount of refund claimed

Rs._______________________

08. Evidence in support of export on account of which, refund is claimed (copies of documents to be enclosed)

09. The basis on which the amount of refund of input tax has been claimed (Documentary evidence, if any, to be enclose)

DECLARATION

10.

I, Sri ____________________________________status________________________________ of the business________________________________at___________________________________ bearing

TIN

,do hereby declare that what is stated in this form is true and correct to the best of my knowledge and belief . I also further declare that the amount of refund claimed above has been paid by me and that the amount or any part thereof has not been realized by me by way of tax or otherwise from any person or persons.

Place____________________________

Date _____________________________

Signature

(Seal)