Form A-XII Application for Deferment under section 96 of the Bihar Value Added Tax Act, 2005 [See rule 57(2)] Office of the .................................................................................. of Commercial Taxes ...................................................................................Circle To, The ........................................................................... .................................................................................................................... circle. I ................................................................................................... (full name), son of ...................................................................................................... (full name) hereby apply for the grant of a deferment under section 96 of the Bihar Value Added Tax Act, 2005 and furnish the following particulars for that purpose - 1. Name and style of Business ........................................................................................................................................................................................ ........................................................................................................................................................................................ 2. Taxpayer Identification No. ........................................................................................................................................................................................ 3. Notification No. under which ........................................................................................................................................................................................ exemption from tax under clause (b) of sub-section (3) of section 7 of Bihar Finance Act, 1981 was granted 4. Certificate number and date ........................................................................................................................................................................................ under which exemption from tax under clause (b) of sub-section (3) of section 7 of the Bihar Finance Act, 1981 was granted (attach copy) 5. Period/Quantum of Entitlement admissible vide certificate mentioned at item 4 above: (a) Date till which exemption admissible .................................................................................................................................................... (b) Monetary Ceiling .................................................................................................................................................................................................... 6. Amount of exemption already availed on .................................................................................................................................................... the appointed date 7. Quantum of unavailed entitlement in .................................................................................................................................................... terms of the explanation to rule 57 DECLARATION I do hereby declare that the particulars furnished in this application are correct and complete to the best of my knowledge and belief. Place ................................................... Signature of the Applicant ......................................................................... Date ................................................... Status in relation to the dealer ......................................................................... Permanent Address ....................................................................................................................................................................................................................................... ................................................................................................................................................................................................................................................................................... ... continued -2 - The application shall be signed by the proprietor of the business if an individual; by the Karta, if an undivided Hindu family; by an authorized partner in the case of a firm; by a managing director, managing agent or principal executive officer in the case of a company or corporation; by the Principal executive officer-in-charge of in the case of a society, club, association, department of Government or local authority. ACKNOWLEDGEMENT Received on ................................................... from .................................................................................................................... an application in Form A-XII for deferment of tax payable under the Bihar Value Added Tax Act, 2005. Signature of Receiving Authority ............................................................ Designation ............................................................................................................................
