FORM 16 (See rule 26 of the Goa Tax on Luxuries, Rules, 1988) Book No. ... Voucher No. . REFUNDS Counterfoil order for the refund of tax and/ or penalty, under the Goa Tax on Luxuries Rules, 1988. Refund payable to ..... Registration Certificate No. .... issued by Luxury Tax Officer, ..... Ward Date of Order directing refund . Amount of refund : (a) Rs. .... Number in collection register showing the collection of amount regarding which refund is made:..... (Signed) .. Designation ..... Dated ..... Signature of recipient of the voucher. .. Treasury/ Sub-Treasury Date of encashment in the State Bank of India Reserve Bank of India Sub/Treasury of India Bank of India Date .... Place ... (a) Classification: Rs. Paise Tax.... FORM 16 (See rule 26 of the Goa Tax on Luxuries, Rules, 1988) Book No. ... Voucher No. . REFUNDS Order for the refund of tax and/ or penalty under the Goa Tax on Luxuries Rules, 1988. Treasury/ Sub-Treasury Payable at the State Bank of India Reserve Bank of India within one month of the date of issue. To, The Treasury/ Sub Treasury officer, The Agent or Manager of State Bank of India Reserve Bank of India 1. Certified that with reference to the assessment record of ........ bearing Registration Certificate No. ...... (issued by the Luxury Tax Office of ..... Ward), for the period from ...... to ......., a refund of Rs...... is due to ...... 2. Certified that the amount of tax and/ or penalty concerning which this refund is allowed has been duly credited to the Government Treasury. 3. Certified that no refund order regarding the sum now in question has been previously been granted and this order of refund has been entered in the original file of assessment under my signature. 4. Please pay to .......... the sum of Rs. ...... (in figures) Rupees ........ (in words) Penalty ... Date .. (Signed).... Designation .... Treasury/ Sub-Treasury Date of encashment in the State Bank of India Reserve Bank of India Date ..... Place ...... Pay Rupees ........ Only. The.198..Officer-in-charge of Treasury/Sub-Treasury The Banks Branch Received payment. Claimant's Signature... Examined, Accountant (a) Classification: Tax ... Penalty .... Rs. Paise Third copy of the Refund Voucher is identical with the second copy and it is not reproduced here
