Form A-III Application for grant of certificate for non-deduction of tax form bills of a supplier registered under the Bihar Value Added Tax Ordinance, 2005 [See rule 28(2)] Office of the .................................................................................. of Commercial Taxes ...................................................................................Circle To, The ........................................................................... .................................................................................................................... circle. I ................................................................................................... (full name), son of ...................................................................................................... (full name) hereby apply for the grant of certificate in form C-III under rule 28(1)(b) of the Bihar Value Added Tax Rules, 2005 and furnish the following particular for that purpose - 1. Name and style of Firm ........................................................................................................................................................................................ ........................................................................................................................................................................................ 2. Taxpayer Identification No. ........................................................................................................................................................................................ 3. Name and complete address ........................................................................................................................................................................................ of the authority/person to whom the goods are to be ........................................................................................................................................................................................ supplied ........................................................................................................................................................................................ 4. Value of Goods to be supplied ........................................................................................................................................................................................ DECLARATION I do hereby declare that the particulars furnished in this application are correct and complete to the best of my knowledge and belief. I further declare that tax payable in regard to the supplies mentioned at serial number 4 above shall be deposited by me in ................................................................................................... (Name of the circle) as and when the tax thereon becomes due for payment. Place ................................................... Signature of the Applicant .......................................................... Date ................................................... Status in relation to the dealer ..............................................................................................................
