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FORM VAT- XXVI

[See rule 9(1)]

APPLICATION FOR REFUND OF TAX UNDER SECTION 34(1) OF THE GOA VALUE ADDED

TAX ACT, 2005(Act 9 of 2005)
(1) Name and address of the Employer of the applicant dealer(exporter)................................................
(2) TIN
           
(3) Quarter/period during which sales are made and in respect of which the refund is claimed...............
(4) Amount of refund claimed..............................................................
(5) Details of sales (a separate Annexure to be attached in the following proforma):
Sr.No.
Sale Invoice
Description of Goods
Quantity
Sale price of goods
Name and address of the purchaser
Mode of dispatch with supporting documents
Mode of Payment
No.
Date
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
         
         
         

(6) Details of purchases of goods made within the State against the Tax Invoices related to aforesaid sale of goods (a separate Annexure to be attached in the following proforma).
Sr.No.
Dealer from whom goods purchased (Name & address)
TIN
Tax Invoice
Description of goods
No.  
Date  
(1)
(2)
(3)
(4)
(5)
(6)
      
      
      
Quantity
Price of goods
Tax Charged
Purpose of purchase i.e. for use in manufacture or for resale.

(7)
(8)
(9)
(10)
    
    
    
 7) The return for aforesaid period in Form VAT - VIII and in Form I under the Central Sales Tax (Registration and Turnover) Rules, 1957 are filed separately.
 DECLARATIONI , hereby, declare that the above particulars are true to the best of my knowledge and belief. Further, I declare that no application for refund in respect of the present claim has made earlier.

Place:  



Date:


___________________________________

Signature of the dealer or his authorised representative

Status:............................

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Commissioner of Commercial Taxes, Vikrikar Bhavan, MG Road, Panjim, Goa, India. Ph.:0832-2229225
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