FORM VAT - IV [See rule 6(7) of the Goa Value Added Tax Rules, 2005] (1) TIN:- D D M M Y Y Y Y (2) Name of the Dealer :______________________ (3) Address of the Dealer :______________________ (4) Style of Business :______________________ (5) Nature of Business :______________________ (6) Total turnover of Sales received and receivable during the period : Rs.___________________ (7) Amount of Composition Tax : Rs.___________________ payable. (8) Amount of Composition Tax paid : Rs.___________________ (9) Number and date of receipted copy of chalan under which payment is is made, attached to this return in proof of payment. :______________________ (10) Details of Bank Account (only the changes in the Bank Account, if any, during the return period to be reported.) DECLARATION I Shri/Smt___________________of M/s _______________________do solemnly declare that the particulars disclosed in this return are true to the best of my knowledge and belief and that I / we have not been covered under any of the contingencies stated in sub-rule(7) of Rule 6 during the period covered under this return. Place: ____________________ Date: (Signature of the dealer)
