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FORM VAT- V (ORIGINAL)

[See rule 24(3)]

CHALLAN

0040 - Taxes on Sales, Trade, etc.

........................


ORIGINAL (To be retained by the payer)

Challan of tax, licence and registration fees and other receipts paid into the..................(Branch) for the period from.................... to..............

 

{

 

Treasury/Sub -Treasury

State Bank of India

__________________

 
TIN

           


Name and address of the dealer on whose behalf money is paid..............................................................

By whom tendered...................................................


Payment on account of
Amount

(in figures)

Rs.


105 - Value Added Tax

01 - Tax Collection

02 - Composition of Tax

03 - Licence & Registration Fees

04 - Interest

800 - Other receipts

81 - Other items

 
Total


 

Rupees (in words) .....................................................................................................................

Dated:.........................

.................................................
(Signature of dealer or depositor)

___________________________________________________________________________________

(For use in the Treasury/Bank)


1. Received payment of Rs...............................................................................(in figures)

Rupees....................................................................................................(in words)

2. Date of entry..............

3. Chalan/Scroll No..............

_____________________

(Signature of Accountant)





(Stamp of Treasury/Bank)

____________________________

(Signature of Treasury/Bank Officer/Manager)

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