1.

Business Status

(Tick any one)

01) Proprietary. 02) Partnership Firm. 03) Private Limited Company. 04) Public Limited Company. 05) Statutory authority. 06) Society. 07) Trust. 08) HUF. 09) Others (Please Specify )

2.

(Based on your business status, furnish details in the appropriate part of Sl. No 2, below)

2-A.

For proprietary concern*

2.1

Name of the proprietor.

2.2

Trade Name

2.3

Father’s/Mother’s/Husband’s Name

2.4

Date of Birth

dd

mm

yy

2.5

Sex (M or F)

2.6

PAN Number

2.7

ECC Number (Issued by Central Excise Dept.)

2.8

Residential Address (Permanent):

Number & Street

Area or Locality Village / Town /City

District

PIN Code

State

2.9

Residential Address (Temporary):

Number & Street

Area or Locality Village / Town /City

District

PIN Code

State

2-B.

For Partnership concern*
(Form VAT 4 should also be filed separately)

2.1

Number of the partners

2.2

Names of all the partners

1.

2.

3.

2.3

Trade Name

2.4

Name of the managing partner or Partner

authorized to Sign

2.5

PAN number of the Partnership firm:

2.6

ECC Number (Issued by Central Excise Dept.)

2.7

Is the partnership deed filed Yes/No

2-C.

For a company/Society/Trust/ Statutory body/Associations of persons & others*

2.1

Name of the Company/ Society/ Trust/ Statutory body / Associations/ Others (Enclose copy of MoA /AoA/Bye laws/Trust deed, etc.)

2.2

Date of incorporation / Registration

2.3

Name & address of the Statutory Authority with whom the entity is incorporated.

(copy of the certificate of incorporation / Registration etc to be filed)

2.4

Trade Name

2.5

PAN Number

2.6

ECC Number (Issued by Central Excise Dept.) (Form VAT 4 should also be filed separately for Association of Persons)

2-D.

For HUF*

2.1

Name of the Kartha

2.2

Date of Birth of the Kartha

2.3

Father’s/Mother’s/Husband’s Name

2.4

Number of members in HUF
(Furnish the address, age and sex of all the
HUF members, in a separate sheet)

2.5

Trading Name

2.6

PAN of HUF

2.7

ECC Number (Issued by Central Excise Dept.)

2.8

Residential Address of the Kartha

(Permanent):

Number & Street

Area or Locality

Village / Town /City

District

State

PIN Code

2.9

Residential Address of the Kartha

(Temporary):

Number & Street

Area or Locality

Village / Town /City

District

State

PIN Code

3.

Business Address :

Number & Street

Area or Locality

Village / Town/City

District

PIN Code

(If you have more than one place of business
or you are a corporate body seeking separate
registration or any unit, fill up Form VAT 3.)

4.

Contact Numbers : (See note below)

Telephone

Mobile

Fax

Email

Specimen Signature (See note below)

1.

File Form VAT 5 if you authorize any other

person for signing returns or statements

2.

3.

6.

Business Details :

Type of Business :
Manufacturer/Wholesaler/Retailer/
Contractor/Hotelier/ Others (Specify)

7

Commodities dealt:

(Specify all the commodities)

Sl. No.

Traded

Manufactured

8.

Date of Commencement of business

9.

Turnover estimated for the financial year

10.

Do you wish to register for VAT or

Composition Tax?

VAT

COT

BOTH

11.

If you wish to register under COT/BOTH, mention the category (Please tick appropriate box/item)

Dealer

Under section 15(1)(a)

Hotelier / Restaurateur

/ Caterer / Sweet meat

stall / Bakery /

Ice-cream Parlor.

Mechanized Stone

Crushing unit -

granite/non-granite

Works Contractor

12.

Do you maintain computerised accounts ?

13.

Are you a regular Importer ?

14.

Are you a regular Exporter ?

15.

Will you make sales of exempted goods ?

16.

Do you wish to apply for registration under

the CST Act, 1956?

Yes / No

17.

If Yes, file separately Form A under the CST (R and T) Rules, 1957. Mention the

commodities which you propose to purchase against declarations under Section 8(1) of the CST Act, 1956 as required in serial number 16 of Form A of the said Rules.

(a)

For

resale

(b)(i) For use in the

manufacture or

processing of goods

for sale

(c) For use in

mining

(d) For use in the

generation of

distribution of

electricity or any

other form of power

(e) For use in the

packing of goods for

sale / Resale.

(b)(ii) For use in the

Telecommunications

network.

18.

Do you deal in goods taxable under the KTEG

Act 1979?

Yes / No

19.

If yes, indicate the commodity proposed to be

dealt :

Additional Information :

Bank Details :

20.

Name of the Bank & Address of the Branch

21.

Bank Code (IFC)

22.

Account Number

23.

Type of Account

(If you operate more than one Bank Account, give details on a separate sheet)

I hereby apply for registration under KVAT/KTEG/CST Acts and declare that the details furnished above are true and correct to the best of my knowledge.

Check Memo

(To be completed by the Department after enquiry / visit)

Signature of the person with
his relation to business

Signature and seal of the
(LVO / VSO)

TIN:

Name of the proprietor/partner/ member/authorised signatory:* *Strike out which are not applicable

Are you a corporate body seeking separate registration for your units:    YES/NO

If yes, furnish the TIN of each such unit while filling the address of such unit/additional place.

1

Trade/Unit’s name :

TIN (if it is a unit of a corporate body having separate

registration) :

Number & Street :

Area or Locality :

Village/Town/City :

District :

PIN Code :

Tel No. :

2

Trade/Unit’s name :

TIN (if it is a unit of a corporate body having separate

registration) :

Number & Street :

Area or Locality :

Village/Town/City :

District :

PIN Code :

Tel No. :

Signature :

Status :

Date :

Note: If there are more than two additional places of business, give details of other places as above on a separate sheet.

Date of receipt:

LVO/VSO Code:

Authorising Officer

Code:

LVO/VSO Location:

FORM 4

[See rule 6]

FORM FOR FURNISHING DETAILS OF PARTNERS AND MEMBERS OF ASSOCIATION OF

PERSONS

TIN:

Name of the Authorised Partner or Managing Partner of Partnership firm or person of the Registered Association who submits the details:

(Following details of each partner or Member of Association is to be furnished)

1.

Name of the Partner/Member :

Father's Name :

Contact Address :

PAN as an Individual

Tel No :

Date of Birth :

Date of entry to Partnership/Association :

Date of leaving Partnership/Association :

Signature of the Partner/Member :

2" x 2"

Photo

2

Name of the Partner/Member :

Father's Name :

Contact Address :

PAN as an Individual

Tel No :

Date of Birth :

Date of entry to Partnership/Association :

Date of leaving Partnership/Association :

Signature of the Partner/Member :

2" x 2"

Photo

3

Name of the Partner/Member :

Father's Name :

Contact Address :

PAN as an Individual

Tel No :

Date of Birth :

Date of entry to Partnership/Association :

Date of leaving Partnership/Association :

Signature of the Partner/Member :

2" x 2"

Photo

4

Name of the Partner/Member :

Father's Name :

Contact Address :

PAN as an Individual

Tel No :

Date of Birth :

Date of entry to Partnership/Association :

Date of leaving Partnership/Association :

Signature of the Partner/Member :

2" x 2"

Photo

Signature:

Status:

Date:

Date of receipt:

LVO/VSO Code:

Authorising Officer

Code:

LVO/VSO Location:

*FORM VAT 5

[See rule 171]

Form for appointment of Authorised Signatories

TIN

Name of the Proprietor/Partner/person who submits the application

Name of Authorised Signatory-1

Signature

Name of Authorised Signatory-2

Signature

Name of Authorised Signatory-3

Signature

Name of Authorised Signatory-4

Signature

I certify that the above named person/s is/are authorised to sign VAT returns and other statements on my/ our behalf.

Name :

Date :

Signature :

Status :

Date of receipt:

LVO/VSO Code:

Authorising Officer

Code:

LVO/VSO Location:

*FORM VAT 7

[See rule 9(1)]

VALUE ADDED TAX REGISTRATION CERTIFICATE

TIN:  ……         

PHOTO

This is to certify that ………………… …………………, whose principal place of business is situated at …........................... .........................................has been registered as a dealer under Section 22 of the Karnataka Value Added Tax Act, 2003, subject to the provisions of the said act and Rules made there under.

*This is to certify that ...................................situated at...................................which is a unit of ................................... a body corporate with its principal place of business at ...................................and having TIN ................................... has been registered separately as a dealer under Section 22 read with Section 38(6) of the Karnataka Value Added Tax Act, 2003, subject to the provisions of the said Act and Rules made there under.

The dealer has additional place(s) of business as noted below:

(1)**

(2)**

(3)**

The aforementioned dealer is authorized to collect tax on his /her sales as specified in the

said Act from ......................................................................

*The dealer has also opted for payment of tax under composition scheme under section 15

under the category ......................................................................

This certificate is valid from ......................................................................until cancelled.

*CST Act, 1956: The said dealer is also registered under the provisions of CST Act, 1956. He is

permitted to purchase the following class of goods availing concessional rate of tax under Section

8(1) of the CST Act, 1956 with effect from ...................................

*The dealer is also registered under the KTEG Act, 1979.

Place ……………………..

Signature

Date ………………………

LVO / VSO(Seal)

*FORM VAT 8

[See Rule 137 (2)]

COMPOSITION TAX REGISTRATION CERTIFICATE

TIN: ………………………………

PHOTO

This is to certify that ________________________________________ whose principal place of business is situated at ___________________________ has been registered as a dealer under Section 22 of the Karnataka Value Added Tax Act, 2003 and permitted to pay tax by way of composition under section 15 in respect of his business of .............. ........ ........ ...... ........................subject to the provisions of the said Act and Rules made there under.

The dealer has additional place(s)  of business as noted below:

(1)

(2)

(3)

The aforementioned dealer is*/is not* authorized to collect tax  on his / her sales.

This certificate is valid from __________________ until cancelled.

Place ……………………..

Signature

Date …………

……………

LVO / VSO    (Seal)

b)(i)For use in manufacture or processing of goods for sale  

(ii)For use in the telecommunication net work    

Place: Bangalore

Signature

Date ………………………

LVO / VSO    (Seal)

1

General Information:

1.1

LVO/VSO CODE                         

1.2

Tax Period (Month/Quarter) :

1.3

Type of return :                       

Original / Corrected / Revised / Final

1.4

Date of filing return :

1.5

TIN :

1.6

Full Name of the dealer       

1.7

Address of the dealer  

1.8

Tax invoices issued in the month*:   

From:                                   To:

PARTICULARS OF TURNOVERS

Local

Interstate/Exports/Import /Consignment

2

Total Turnover

3

Total Turnover

2.1

Sales return, discounts, labour charges, etc. as per Rule 3(2)

3.1

Sales return, discounts, labour charges, etc.

2.2

Consignment  Sales /C.A. Sales

3.2

Stock Transfers  /

Consignment Sales

2.3

Tax Collected (VAT)

3.3

Exempted Sales

2.4

Exempted Sales

3.4

Direct Exports

2.5

Others

3.5

Deemed Exports

(against H Form)

2.6

Taxable Turnover (local)

[Box 2 less (Box 2.1 to Box 2.5)]

3.6

Sales in Transit

(E-1 and E-II)

3.7

Sales in the course of import                 (including High Sea Sales)

3.8

CST Collected

3.9

Taxable Turnover (Interstate)

[Box No.3 less (Total of Box Nos.3.1 to 3.8)]

4

Net Tax Payable

4.1

Output Tax Payable                         (Refer Box No. 8.3)

4.2

Brought forward credit of / excess payment made during previous month (Refer Box No.4.10)

4.3

Input tax credit (Refer Box No.11)

4.4

Tax Payable [Box No.4.1 less (Box No.4.2 + Box No 4.3)]

4.5

Tax deducted at source(Certificate/s enclosed)

4.6

Tax already paid in the original return

4.7

Balance tax payable [Box No. 4.4 less (Box No. 4.5+ Box No.4.6)]

4.8

Adjustment of any excess credit towards KST / KTEG / KSTECG

4.9

Refund **                           Yes / No

4.10

Credit / excess payment carried

forward **                          Yes / No

4.11

Net Tax refund as per Incentive Notification

**Note.- If you exercise option ‘Yes’ in both Box Numbers 4.9 and 4.10, then the option exercised in respect of Box Number 4.10 alone shall be considered.

5

Tax payment details

Details

Amount

Cash/DD/ Chq/

Challan No:

Bank

Date

5.1

Tax Payable as per Box No.4.7

5.2

Interest

5.3

Others

5.4

Total of Box  Nos.5.1, 5.2 and 5.3

FOR CTD / BANKS USE ONLY

Date of Receipt of return :

Received Rs.

In words Rs.

Challan No.       :

Date:

Signature and Seal of LVO/VSO

* Note :  If the serial numbers of Tax Invoices are of different series then it should be mentioned separately.

6

Details of local sales/purchases from un-registered dealers and output tax/purchase tax payable

6.1

Taxable turnover of sales with rate of tax of 1 %

6.9

Output tax payable

(relating to Box No.6.1)

6.2

Taxable turnover of sales with rate of tax of 4 %

6.10

Output tax payable

(relating to Box No.6.2)

6.3

Taxable turnover of sales with rate of tax of 5 %

6.11

Output tax payable

 (relating to Box No.6.3)

6.4

Taxable turnover of sales with rate of tax of 13.5 %

6.12

Output tax payable

(relating to Box No.6.4)

6.5

Taxable turnover of sales with rate of tax of 15 %

6.13

Output tax payable  (relating to Box No.6.5)

6.6

Taxable turnover of sales with any other rate of tax (specify rate of tax)

6.14

Output tax payable

(relating to Box No.6.6)

6.7

Taxable turnover of purchases from un-registered dealers (specify rate of tax)

6.15

Output tax payable

(relating to Box No.6.7)

6.8

Total taxable turnover

(Box No.6.1 to  6.7)

6.16

Total output tax payable 

(Box No.6.9 to  6.15)

7

Details of Interstate Sales and CST Payable

7.1

Taxable turnover of sales against C Forms  at 1 % tax

7.10

Output tax payable

(relating to Box No.7.1)

7.2

Taxable turnover of sales against C Forms  at 2 % tax

7.11

Output tax payable

(relating to Box No.7.2)

7.3

Taxable turnover of sales without C Forms  at 1 % tax

7.12

Output tax payable

(relating to Box No.7.3)

7.4

Taxable turnover of sales without C Forms  at 4 % tax

7.13

Output tax payable

(relating to Box No.7.4)

7.5

Taxable turnover of sales without C Forms at 5 % tax

7.14

Output tax payable

(relating to Box No.7.5)

7.6

Taxable turnover of sales without C Forms  at 13.5 % tax

7.15

Output tax payable    (relating to Box No.7.6)

7.7

Taxable turnover of sales without C Forms at 15 % tax

7.16

Output tax payable

 (relating to Box No.7.7)

7.8

Taxable turnover of sale at any other rate of  tax (specify rate of tax)

7.17

Output tax payable  (relating to Box No.7.8)

7.9

Total taxable turnover

(Box No.7.1 to   7.8)

7.18

Total output tax payable (Box No.7.10 to  7.17)

8.1 Total Out Put Tax (Total of Box No. 6.16 and Box No. 7.18)

Less

8.2 Output Tax deferred to Industries as per Incentive Notifications

8.3 Net Output Tax Payable (Box No. 8.1 Less Box No. 8.2)

9

Details of Purchases and Input Tax

9.1

Net value of  purchases

at 1% tax

9.14

Input tax

(relating to Box No.9.1)

9.2

Net value of purchases  at

 4 % tax

9.15

Input tax

(relating to Box No.9.2)

9.3

Net value of purchases

at 5 % tax

9.16

Input tax

(relating to Box no.9.3)

9.4

Net value of purchases

at 13.5 % tax

9.17

Input tax

(relating to Box No.9.4)

9.5

Net value of purchases

at 15 % tax

9.18

Input tax

(relating to Box No.9.5)

9.6

Value of URD purchases to the extent used or sold during the month/quarter(specify rate of tax):

9.6.1  Brought forward from previous period

9.6.2  Relating to current tax period

9.6.3  Total

9.19

Input tax

(relating to Box No.9.6.3)

9.7

Others, if any

(please specify)

9.20

Input Tax

(relating to Box No.9.7)

9.8

Value of URD purchases to the extent not used or sold (specify rate of tax):

9.8.1  Brought forward from previous period

9.8.2  Relating to current tax period

9.8.3  Total

9.21

Input tax carried forward (relating to Box No.9.8.3)

9.9

Value of VAT exempted goods.

9.10

Value of purchases from composition dealer

9.11

Value of goods imported and / or  purchased in the course of import / export / inter-State trade including E-I and E-II  purchases.

9.12

Value of goods received

by stock transfer /

consignment transfer

9.13

Total value of purchases

(Total of Box Nos. 9.1 to 9.5, 9.6.2, 9.7, 9.8.2 and 9.9 to 9.12)

9.22

Total input tax  (relating to

Box No.9.14 to 9.20)

10

Ineligible Input Tax Credit

10.1

Non-deductible input tax being restricted under Section 11

10.2

Non-deductible input tax relating to pre-registration purchases under Section 13

10.3

Non-deductible input tax-under special rebating scheme under Section 14 read with Section 11

10.4

Non-deductible input tax as per partial rebating scheme under Section 17

10.5

Non-deductible input tax relating to return of goods purchased

10.6

Others, please specify

10.7

Total ineligible Input Tax Credit (Total of Box No. 10.1 to Box No. 10.6)

11

Eligible Input Tax Credit (Box No. 9.22 – Box No. 10.7)

DECLARATION

        I / We Declare that the particulars furnished above are true and complete in all respects. I / We hereby declare that I am / we are aware that there are penalties for making false declarations or incomplete returns.

Place :                                                                                                Signature :

Date  :                                                                                 Name and designation / Seal:

12

ENTRY TAX

(Applicable to dealers’ who are liable to tax under the Karnataka Tax on Entry of Goods Act, 1979)

12.1

VALUE OF TOTAL PURCHASES : Value of goods liable for entry tax  local, inter-State and imports including freight and inward expenses

LESS:

12.2

Value of purchases within the local area,  purchases against Form 40, purchase returns and re-exports

12.3

Other deductions

12.4

Taxable Value

CALCULATION OF ENTRY TAX PAYABLE

Description of the goods

Taxable value

Tax payable

12.5

Goods  taxable @1%

12.6

Goods  taxable @2%

12.7

Goods  taxable @5%

12.8

Goods  taxable at other rate (specify)

12.9

Total

12.10

Tax already paid in the original return

12.11

Balance of tax payable (12.9 –12.10)                                     

12.12

Tax paid particulars; Rs………  Cash/DD/Challan No………..Date…………..

Bank…………..

          I / We declare that the particulars furnished above are true and complete in all respects.

Place :                                                                                                        Signature :

Date :                                                                                          Name and designation / Seal:

Incomplete forms will be deemed to be invalid and penalties relating to non-filing will apply.

Note: If the Return is not applicable then it can be written as “N.A”

SPECIAL ENTRY TAX

13

(Applicable to dealers who are liable to tax under the Karnataka Special Tax on Entry of Certain Goods Act, 2004)

TOTAL PURCHASES :

13.1

Value of goods liable for tax-inter-State and imports including freight and inward expenses

LESS:

13.2

(a)  Exemption (please specify)

(b)  Purchase returns

(c)  Re-exports

(d)  Others

13.3

TAXABLE TURNOVER

Description of the notified goods

Taxable value

Tax payable

13.4

Goods taxable @5%

13.5

Goods taxable @ 13.5%

13.6

Goods  taxable at other rate (specify)

13.7

TOTAL

13.8

Less: CST paid as per Section 4(2)

13.9

Balance tax payable

Tax paid particulars: Rs.                           Cash / DD / Challan No:

Date :                         Bank:

        I / We declare that the particulars furnished above are true and complete in all respects.

Place :                                                                               Signature :

Date :                                                                                Name & Designation / Seal :

Incomplete forms will be deemed to be invalid and penalties relating to non-filing will apply.

Note :    If the return is not applicable then it can be written as “N.A.”

ANNEXURE- I

Details of statutory forms filed for the quarter ending 30th June, 30th September, 31st December and 31st March *

A. Extract  for quarter

Nature of statutory

Form filed

Turnover for which statutory Forms to be filed for the quarter

Turnover mentioned in the  statutory forms filed for the quarter ending

Balance Turnover for which statutory forms are to be filed

Number of statutory forms filed

CST:

(1) C Form

(2) F Form

(3) H Form

(4) I Form

(5) E -I Form

(6) E -II  Form

(8) C Form related to

E -I/E -II Form

            I / We declare that the particulars furnished above are true and complete in all respects.

Place:                                                                                                           Signature :

Date :                                                                                                Name & designation / Seal :

B. DETAILS  (Statutory forms filed along with this annexure)   for quarter:

SL.

No

Type of Statutory

Forms

Number of Statutory Forms

Net Value

Tax Amount

Total Amount

NOTE: (1) Dealers shall furnish the detailed statement indicating particulars and the numbers of the

                  statutory forms filed separately if the space provided is not sufficient.

             (2) The information should be provided for each tax period relating to the said quarter.

              I / We declare that the particulars furnished above are true and complete in all respects.

 Place:                                                                                                           Signature :

 Date :                                                                                               Name & designation / Seal :

Note:

Quarter ending

Last date to file statutory Forms

30th June

30th September

30th September

31st December

31st December

31st March

31st March

30th June

ANNEXURE II

Details of purchases including receipts and sales including stock transfers for the month / quarter ...

1. Purchases and receipts by way of consignment / stock transfer.-

Sl.

No.

Description of goods

Net value

Amount of VAT paid

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

2. Sales and disposals by way of consignment / stock transfer.-

Sl.

No.

Description of goods

Net value

Amount of VAT / CST paid (specify)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

1)

General Information:

1.1)

LVO/VSO CODE

1.2)

Tax Period: (Month/Quarter):

1.3)

Type of return

Original / Corrected / Revised / Final

1.4)

Date of filing return :

1.5)

TIN :

1.6)

Full Name of the dealer :

1.7)

Address of the dealer :

1.8)

Tax invoices issued in the month*:

From:

To:

PARTICULARS OF TURNOVERS

Local

Interstate/Exports/Import

/Consignment

2)

Total Turnover (local)

3)

Total Turnover

2.1)

Sales return, discounts, labour charges etc. as per Rule 3(2)

3.1)

Sales return, discounts, labour charges etc.

2.2)

Consignment Sales / C.A. Sales

3.2)

Stock Transfers / Consignment Sales

2.3)

Tax Collected (VAT)

3.3)

Exempted Sales

2.4)

Exempted Sales

3.4)

Direct Exports

2.5)

Others

3.5)

Deemed Exports (Against H Form)

2.6)

Taxable Turnover (local) [Box 2 less (Box 2.1 to Box 2.5)]

3.6)

Sales in Transit (E-1 and E-II)

3.7)

Sales in the course of import (High Sea Sales)

3.8)

CST Collected

3.9)

Taxable Turnover (Interstate) (Box no.3 less (Total of Box no.3.1 to 3.8))

4.

Net Tax Payable

4.1)

Output Tax Payable (Refer Box no.8.3)

4.2)

Brought forward credit of / excess

payment made during previous month

(Refer Box No.4.10)

4.3)

Input tax credit (Refer Box No.11)

4.4)

Tax Payable [Box No.4.1 less (Box No.4.2 + Box No 4.3)]

4.5)

Tax deducted at source (Certificate Enclosed)

4.6)

Tax already paid in the original return

4.7)

Balance Tax Payable [Box No. 4.4 less (Box No. 4.5 + Box No. 4.6)]

4.8)

Adjustment of any excess credit towards

KST / KTEG / KSTECG

4.9)

Refund ** Yes / No

4.10)

Credit / excess payment carried forward ** Yes / No

4.11)

Net Tax refund as per Incentive Notification

**Note: If you exercise option “Yes” in both box numbers 4.9 and 4.10, then the option exercised in respect of box number 4.10 alone will be considered.”

5.

Tax payment details

Details

Amount

Cash/DD/Chq/Challan No:

Bank

Date

5.1)

Tax Payable as per Box No.4.7

5.2)

Interest

5.3)

Others

5.4)

Total of Box No.5.1, 5.2 and 5.3

FOR CTD / BANKS USE ONLY

Date of receipt of return

Received. Rs.

In words Rs.

Challan No.

Date:

Signature and Seal of LVO/VSO

6.

Details of local sales/purchases from un-registered dealers and output tax/purchase

tax payable

*Total of
actual net
sale price

*Taxable
turnover
on MRP
basis

*As per
actual
sale
price

*On
MRP
basis

(1)

(2)

6.1

Sale of goods with
rate of tax of 1%

6.9

Output tax Payable (relating to Box No.6.1)

6.2

Sale of goods with
rate of tax of 4 %

6.10

Output tax Payable (relating to Box No.6.2)

6.3

Sale of goods with
rate of tax of 5%

6.11

Output tax Payable (relating to Box No.6.3)

6.4

Sale of goods with
rate of tax of 13.5%

6.12

Purchase tax Payable (relating to Box No.6.4)

6.5

Sale of goods with
rate of tax of 15 %

6.13

Output tax Payable (relating to Box No.6.5)

6.6

Sale of goods with any other rate of tax (specify rate of tax)

6.14

Output tax Payable (relating to Box No.6.6)

6.7

Taxable turnover of purchases
from unregistered dealers
(specify rate of tax)

6.15

Output tax Payable (relating to Box No.6.7)

6.8

Total taxable turnover (Box No.6.1 to 6.7)

6.16

Total Output Tax Payable (Box No 6.9 to 6.15)

*Note: Fill up only the relevant column.

7.

Details of Interstate Sales and CST Payable

7.1

Taxable turnover of sales against C Forms at 1 % tax

7.10

Output tax Payable (relating to Box No.7.1)

7.2

Taxable turnover of sales against C Forms at 2 % tax

7.11

Output tax Payable (relating to Box No.7.2)

7.3

Taxable turnover of sales without C Forms at 1 % tax

7.12

Output tax Payable (relating to Box No.7.3)

7.4

Taxable turnover of sales without C Forms at 4 % tax

7.13

Output tax Payable (relating to Box No.7.4)

7.5

Taxable turnover of sales without C Forms at 5 % tax

7.14

Output tax Payable (relating to Box No.7.5)

7.6

Taxable turnover of sales without C Forms at 13.5 % tax

7.15

Output tax payable (relating to Box No.7.6)

7.7

Taxable turnover of sales without C Forms at 15 % tax

7.16

Output tax payable (relating to Box No.7.7)

7.8

Taxable turnover of sale at any other rate of tax (specify

rate of tax)

7.17

Output tax payable (relating to Box No.7.8)

7.9

Total taxable turnover

(Box No.7.1 to 7.8)

7.18

Total output tax Payable (Total of Box Nos.7.10 to 7.17)

8.1)

Total Out Put Tax (Total of Box No. 6.16 and Box No. 7.18)

Less:

8.2)

Output Tax deferred to Industries as per Incentive Notifications

8.3)

Net Output Tax Payable (Box No. 8.1 Less Box No. 8.2)

9.

Details of Purchases and Input Tax

*At actual net sale
price

*On MRP
basis

*As
per
actual
price

*As per
MRP

9.1

Value of purchases at 1% tax

9.14

Input tax (relating to Box No.9.1)

9.2

Value of purchases at 4% tax

9.15

Input tax (relating to Box No.9.2)

9.4

Value of purchases at 13.5 % tax

9.17

Input Tax (relating to Box No.9.4)

9.5

Value of purchases at 15% tax

9.18

Input tax (relating to Box No.9.5)

9.7

Value of URD purchases to the extent used or sold (specify rate of tax):
9.7.1 Brought forward from
previous period
9.7.2 Relating to current tax period
9.7.3 Total

9.20

Input tax (relating to Box No.9.7.3)

9.8

Value of URD purchases to the extent not used or sold (specify rate of tax):
9.8.1 Brought forward from
previous period
9.8.2 Relating to current tax period
9.8.3 Total

9.21

Input tax (relating to Box No.9.8.3)

9.9

Value of purchases from composition dealer

9.10

Value of VAT exempted goods.

9.11

Value of goods imported and / or purchased in the course of import / export / inter-State trade including E-I
and E-II purchases.

9.12

Value of goods received
by stock transfer / consignment transfer

.13

Total value of purchases
(Total of Box Nos. 9.1 to 9.6, 9.7.2, 9.8.2 and 9.9 to 9.12)

9.22

Total input tax (relating to Box No.9.14 to 9.20)

* Note: Fill up only the relevant column.

10)

Ineligible Input Tax Credit

10.1

Non-deductible input tax being restricted u/s 11

10.2

Non-deductible input tax relating to pre-registration purchases under Section 13

10.3

Non-deductible input tax-under special rebating scheme under Section 14 read

with Section 11

10.4

Non-deductible input tax as per partial rebating scheme under Section 17

10.5

Non-deductible input tax relating to return of goods purchased

10.6

Others, please specify

10.7

Total ineligible Input Tax Credit (Total of Box No. 10.1 to Box No. 10.6)

11.

Eligible Input Tax Credit (Box No. 9.22 – Box No. 10.7)

DECLARATION

I / We Declare that the particulars furnished above are true and complete in all respects.

I / We hereby declare that I am / We are aware that there are penalties for making false declarations or incomplete returns.

Place :

Signature :

Date :

Name and designation/Seal: