FORM VAT - XXVII [See rule 25(2) of the Goa Value Added Tax Rules, 2005] QUARTERLY STATEMENT OF TAX DEDUCTED AT SOURCE FOR THE PERIOD FROM _________TO __________ (1) Name and address of the Employer : (2) Registration number of the Employer: (3) TIN if any : (4) Total amount of payments made during the quarter Rs. ____________________chalan/scroll no.........dtd.......... (5) Total amount of tax deducted at source Rs. ___________________ (6) Details of remittance : Sr. No. Name & address TIN Period TDS Amount of the contractor * enclose separate statement if necessary DECLARATION I, ____________________do hereby solemnly declare that to the best of my knowledge and belief, the information furnished hereinabove is true and complete. Place: Date: ______________________________________ Signature of the employer or his representative
