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FORM VAT- XVI

[See rule 30(1)of the Goa Value Added Tax Rules, 2005]

Refund Adjustment order

Voucher No. ___________
(1) Name of dealer or person to whom issued_____________________________

(2) TIN (In case of dealer registered under the Act.)

           

(3) Amount of refund due Rs._________________________________

(4) Date of order quantifying the refund amount.____________________________

(5) Details of amount deducted, if any on account of any demand outstanding against the applicant
AmountDemand Notice No. & Date
    

(6) Net refundable amount in figures and words

(In words)__________________________________________________________

(In figures) Rs. ______________________________


(7) The amount of Rs.................to be refunded by issue of Refund Voucher in Form VAT - XII.


Place:

Date:-
 


Signature of Assessing Authority

(Seal of Assessing Authority)
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Commissioner of Commercial Taxes, Vikrikar Bhavan, MG Road, Panjim, Goa, India. Ph.:0832-2229225
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