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Entry Form V


[See rule 8(2)]



The Dealer,


Take notice that according to the statement sent by you for the month .................. under section 18(1) of the Goa Tax on Entry of Goods Act, 2000, you are liable to pay tax of Rs. ............ only for the month of ............ which is still payable by you. You are hereby called upon to pay the said amount within ten days from the date of service of this notice by remittance to the Government Treasury by challan in Form - 27 failing which the amount will be recovered as provided under, sub-section (2) of section 19 of the said Act.

Value of goods as provisionally determined by the Assessing Authority in respect of

Nature of goods Rate of Tax Tax


  Assessing Authority  

Date :

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