FORM 9 [See rule 13 (4)] CHALAN Challan for the Treasury THE GOA TAX ON LUXURIES ACT, 1988 [See rule 13 of the Goa Tax on Luxuries Rules, 1988] 0045 Other Taxes and Duties on Commodities and Services - 105 Luxury Tax (ii) Tax on accommodation. Name and full Address of the hotelier .. Luxury Tax R.C. No. .. G.S.T.R.C. No. if held .. Period from ..... to .. Tax Rs.... Interest U/s. Rs.... Penalty U/s. Rs.... Total Amount Rs.... Amount paid with the Return-cum-Challan (in figures) .. (in words) .. Amount paid in cash/ by cheque No. .... dated ...... of Bank ...... Place .... Signature..... Dated ...... Status ..... For Treasury use only Received Rs. ......... (in figures) Rs. .......................... (in words) Date of entry ..... Challan No. ....... Treasurer/ Accountant, Treasury Officer/ Agent or Manager . Original copy is to be retained by the payer, Duplicate is to be furnished by the payer to the respective Assessing Authority, Triplicate is for the Treasury and Quadruplicate is to be sent by Treasury to the respective Luxury Tax Officer.
