FORM 3 [See Rule 8(1)] Monthly statement of Tax (1) Month and year. (2) Registration certificate No. under the Goa Tax on Entry of Goods Act, 2000. (3) Name and full address of the dealer. (4) Style of business (5) Status (6) Tax payable for the month (as per Table below) (7) Tax paid (Challan/Receipt No. and date to be furnished). (8) Balance due/Excess paid. DECLARATION I, ................... do solemnly declare that to the best of my knowledge and belief the information furnished in the above statement is true and complete and that it relates to the month covering the period from .... to .... SignaturePlace: Name of the Signatory Proprietor/Partner/Manager/Dated: Director Sl. Desc Total Value Value of Value of Purcha Total Total Rate Tax No. ripti value of goods goods sed deductions value of of due on of goods purchas purchas value 4(a)+4(b)+ goods tax (Rs. of goods purch ed/ ed/recei of 4(c)+4(d) liable to Ps) the purch ased/ /receive ved motor tax (3 good ased/ /recei d from from vehicl 4) s /recei ved outside outside e ved from the local the local import (both within area but area, ed from the returne but sent from within local d to the out of outsid and area supplier the local e the outsid s area State e the otherwis on state) e than which by way tax of sale has excludin alread g the y been amount paid shown by under filing col. 4(b) state ment in Form 4 (1) (2) (3) 4(a) 4(b) 4(c) 4(d) (5) (6) (7) (8) (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix) (x) (xi) (xii) (xiii) (xiv) (xv) (xvi) Total:
