FORM 4 (See rule 27) Return for turnover and tax payable by an importer of the Motor Vehicle under the Goa Tax on Entry of Goods Act, 2000 (1) Name and address of the importer: ......................... ..... (2) Registration Certificate No. (if registered): ......................... .. (3) Period of import : From ......... to ........... I. Description of Motor vehicles imported into local area from any place outside the state: Class Model Engine Chasis Purchase Rate Tax Tax Balance due Excess of No. No. value of payable paid paid Motor tax vehicle (1) (2) (3) (4) (5) (6) (7) (8) (9) II. Tax paid Challan No. ............................ ....... DECLARATION I, ................... do solemnly declare that to the best of my knowledge and belief the information furnished in the above return is true and complete and that it relates to the period mentioned above. Signature Name of the signatory
