GOVERNMENT OF JHARKHAND COMMERCIAL TAXES DEPARTMENT Indemnity Bond for loss of Declaration Form in JVAT 505 series [See Rule 35(8), 36(5), 42(9)] I, Sri______________________________ son/daughter/wife of Sri _____________________ residing at _______________________________ P.O. ____________ P.S. _____________________ Dist , Proprietor/Partner/(Managing) Director/Manager/Principal Officer/Authorised officer of the Dealer / Business known as _________________________________ situated at _______________________________________ and possessing a Taxpayers' Identification number bearing TIN_________________ in the State of Jharkhand under the Jharkhand Value Added Tax Act, 2005, do hereby declare that the Declaration form bearing no. ____________________ issued to me/us and authenticated by the Prescribed Authority, _________________________ Circle, ______________ on is lost/destroyed/stolen, (i) from my custody, before being filled in and signed by me; and (ii) from my custody, after being filled in and signed by me, before dispatch to the selling dealer/consignee, namely (iii) in transit, after being duly filled in and signed by me and dispatched to the selling dealer/consignee, namely (Strike out whichever is not applicable) And I, the aforesaid Sri ________________________________ do hereby undertake to hold harmless and to indemnify the Government against any loss arising out of the aforesaid loss of Declaration Form. And I bind myself, my heirs, executors, administrations and assignees and each one of the other person having any share, title or interest in the aforesaid business and his heirs, executors, administrators and assignee jointly and severally for holding harmless and indemnifying the Government for any such loss and aforesaid. Place : Date : Signature of the dealer Designation with relation to the business : Seal
