FORM JVAT 121 GOVERNMENT OF JHARKHAND COMMERCIAL TAXES DEPARTMENT Application for Deferment u/s 95(3) of the Jharkhand VAT Act, 2005 [See Rule 64(2)] Office of the of Commercial Taxes Circle To, Thecircle. I (full name), son of (full name) hereby apply for the grant of a deferment under section 95(3) of the Jharkhand Value Added Tax Act, 2005 and furnish the following particulars for that purpose 1. Name and style of business 2. Taxpayer Identification Number 3. Notification number under which deferment / exemption from tax under Section 23A or under clause (b) of subsection (3) of section 7 of the Adopted Bihar Finance Act, 1981 respectively, was granted 4. Certificate number and date by which deferment / exemption from tax under Section 23A or under clause (b) of subsection (3) of section 7 of the Adopted Bihar Finance Act, 1981 was granted (attach copy) 5. Period/Quantum of entitlement admissible vide certificate mentioned at serial number 4 above (a) Date till which deferment / exemption is admissible (b) Monetary ceiling for availment of the facility 6. Amount of deferment / exemption already availed as on the appointed date 7. Quantum of unavailed entitlement in terms of Rule 64 DECLARATION I do hereby declare that the particulars furnished in this application are correct and complete to the best of my knowledge and belief. Place Signature of the applicant Date Status in relation to the dealer Permanent address
