CHANDIGARH ADMINISTRATION EXCISE & TAXATION DEPARTMENT Form VAT 21 (See Rule 40) Annual Statement by a Registered Person (Read the INSTRUCTIONS CAREFULLY before filling the form) TRN For period (dd.mm.yy) From ________ To __________ Name of the person: Address of the person: Pin State : Tel Fax E-mail address : 1 SALES DETAILS Q1 Q2 Q3 Q4 (a) Gross Sales during the year (b) Less : Tax free sales (c) Less : Deductions (d) Add/less : adjustments, if any. (e) Net taxable sales during the year subject to TOT 2. PURCHASE DETAILS Q1 Q2 Q3 Q4 (a) Gross Purchases 3. OUTPUT TAX Q1 Q2 Q3 Q4 (a) TOT on net taxable sales within the year as per 1 (e) (b) TOT paid (c) Additional amount of tax payable / refundable [3(a) 3(b)] (d) Interest payable, if any, additional tax payable as per 3(c) above Declaration: I solemnly declare that to the best of my knowledge and belief, the information given on this form is true and correct Name Designation Signature Date (dd.mn.yy) 4. TOTAL AMOUNT PAYABLE/ FOR THE YEAR 5. REFUND DUE, IF ANY.