Form VAT - XVI [See rule 30(1)of the Goa Value Added Tax Rules, 2005] Refund Adjustment order Voucher No. ___________ (1) Name of dealer or person to whom issued____________________________________ (2) TIN (In case of dealer registered under the Act.) (3) Amount of refund due Rs._________________________________ (4) Date of order quantifying the refund amount._________________________________ (5) Details of amount deducted, if any on account of any demand outstanding against the applicant. (6) Net refundable amount in figures and words (In words ______________________________________________________________________ (In figures Rs. _______________________________ (7) The amount of Rs.......to be refunded by issue of Refund Voucher in Form VAT - XII. Place: Signature of Assessing Authority Date: (Seal of Assessing Authority)
