FORM IV Return of Tax Payable for the quarter/month ending (year)Day of [ See rules 20 (1),21 to 25 ] Name of the dealer Carrying on business under the trade name of Address in full Registration Certificate No (1) Amounts received and receivable in respect of sale of goods, (other than those on which purchase tax is payable) inside the State during the period. (2) Amounts of purchase price paid and payable in respect of purchase or supply of goods on which purchase tax is payable inside State during the period. TotalDeduct cash discount allowed according to the ordinary trade practice, but separately shown as such. Gross turnoverB. Deductionsi. Turnover of sale or purchase of goods exempted from levy of tax. ii. Turnover on goods sold to registered dealers from whom declarations in Form XXXIV have been obtained. iii. Turnover on any other sales specifically exempted.iv. Collection of sales tax, if any. v. Value of purchases of goods on which purchase tax is payable but which are purchased from registered dealers. TotalApplication Form for Return of Tax Payable for Quarter/ MonthlyGovernment of OrissaFinance DepartmentA.ToFrom/-Rs. YesNoPublished on National Portal of India (india.gov.in) B. Break up of taxable turnover - (i) (ii) (iii) (iv (v Total Tax payableNB:-Deduct tax paid at Check-gate or deemed to have been paid prior to Registration Under provision to Rule 36 C. Tax paid amounting to Rs Challan No. TreasuryBank Surcharge (if any) paid amounting to RsI declare that the above statements are true to the best of my knowledge and belief. Proprietor/Partner/Manager/Principal Officer A. Taxable turnover (A-B) /-Rs.(in words) Rupees only under P.M. ack. Date of Post Office is enclosedBank draft Crossed Cheque YesNo Crossed ChequePublished on National Portal of India (india.gov.in)
