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Entry Form III


[See Rule 8(1)]

Monthly statement of Tax


Month and year.


Registration certificate No. under the Goa Tax on Entry of Goods Act, 2000.


Name and full address of the dealer.
(4) Style of business
(5) Status
(6) Tax payable for the month (as per Table below)
(7) Tax paid (Challan/Receipt No. and date to be furnished).
(8) Balance due/Excess paid.



I, ......................................................... do solemnly declare that to the best of my knowledge and belief the information furnished in the above statement is true and complete and that it relates to the month covering the period from ............ to ............






Name of the Signatory Proprietor/Partner/Manager/Director


Sl. No.

Description of the goods

Total value of goods purchased/ /received (both from within and outside the state)

Value of goods purchased/ /received from within the local area

Value of goods purchased/ /received from outside the local area but returned to the suppliers

Value of goods purchased /received from outside the local area, but sent out of the local area otherwise than by way of sale excluding the amount shown under col. 4(b)

Purchased value of motor vehicle imported from outside the State on which tax has already been paid by filing statement in Form 4

Total deductions 4(a)+4(b)+ 4(c)+4(d)

Total value of goods liable to tax (3-4)

Rate of tax

Tax due (Rs. Ps)





































































































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