(Original/Duplicate/Triplicate/Quadruplicate) Form VAT - XXX [See rule 57] DECLARTION (Under Entry (23) of Schedule 'B' to the Goa Value Added Tax Act, 2005)(Act 9 of 2005) Sr No: Year : I ................(name),.............(designation/status) of M/s ......... (name and address of purchasing dealer) on behalf of the said purchaser do hereby declare that:- (1) I/We am/are registered dealer holding TIN (2) The goods specified in the Tax Invoice No. ......dated......of M/s .......... holder of TIN have been purchased by me/us as Capital goods as defined in the Goa Value Added Tax Act, 2005 (Act 9 of 2005) and that they are properly recorded in our books of accounts. I/we hereby declare that whatever stated above is true to the best of my/our knowledge and belief. Date: Signature.... Place: Status..... N.B.: To be issued in quadruplicate. The 'original' and the 'duplicate' shall be made over by the purchasing dealer to the selling dealer out which the 'original' shall be forwarded by the selling dealer to his Assessing Authority alongwith the return. The 'duplicate' shall be retained by the selling dealer for his record. The 'triplicate' shall be sent by the purchasing dealer immediately on its issue to the Commissioner keeping the'quadruplicate' for his record.
