GOVERNMENT OF JHARKHAND COMMERCIAL TAXES DEPARTMENT Application for Refund of amount forfeited u/s 48 of the Jharkhand VAT Act 2005 [See Rule 21(3)] Office of the ......... of Commercial Taxes ......... Circle To, The............. ........ Circle I............ (full name) son of .......... (full name) hereby apply for the Refund of the amount forfeited u/s 48 of the Jharkhand VAT Act 2005 and furnish the following particular for that purpose. 1. Name and style and complete address of the person/firm from whom tax was collected in contravention of subsection (1) and (2) of Section 47 2. Taxpayer Identification Number, if any, of the firm mentioned at serial number (1) above - 3. Name and style and complete address of the firm collecting the tax in contravention of subsections (1) and (2) of Section 47 - 4. Taxpayer Identification Number of the firm mentioned as serial number (3) above - 5. Number and date of invoice/invoices vide which the tax was collected in contravention of subsections (1) and (2) of Section 47 - 6. Value of goods, tax charged thereon and full value of the invoice/invoices mentioned at serial number (5) above (Attach copy) - DECLARATION I do hereby declare that the above particulars are correct and complete to the best of my knowledge and belief. Place...... Signature......... Date...... Status...........