Kotwani's Value Added Tax 1"Form VAT - 21 [See Rule 28(1)&(2)] Application for Refund by Exporters Registration No. (TIN) 1. Name of Dealer 2. Address Bldg No/Name/ Area Town/City District (State) Alternate e-mail Id 3.1 Name of the Bank in which refund is sought 3.2 Name of the Branch 3.3 Account No. 3.4 Account Type 3.5 IFSC No. of Branch 4. Type of export Under Section 5(1) of the CSTAct, 1956 Under Section 5(3) of the CSTAct, 1956 5. Period for which refund is claimed: From To 6. Amount of Refund claimed (Rs.) ______________________________________________________ 7. Details of purchases of goods for which refund is claimed: 8. Details of the sale deemed in the course of export u/s 5(1): 1. Substituted by clause 8 of the Rajasthan Value Added Tax (Eighth Amendment) Rules, 2008 w.e.f. 30.08.2008 316 The Rajasthan Value Added Tax Forms 317 9 Details of the sale deemed in the course of export u/s 5(3): Sr. No. VAT Invoice No. Date Goods Sold To Reg. No. (TIN) Description of goods Quantity Value (Rs.) Give Details as per rule 28(2)(b) Declaration I declare that I have not taken credit of input tax on purchases for which I have claimed refund and that I have reversed credit of input tax, claimed earlier. Place : Signature Date : Name : Status Undertaking I ...............................................................S/o ......................................................................... resident of ................................. (Status) ........................ of M/s ............................. ............................................... do hereby solemnly affirm on oath that, in case of re-import of the above goods, I will communicate within a period of one month from the date of re-import into India of such goods, to the assessing authority or any other officer authorized by the Commissioner in this behalf and shall repay, forthwith, the amount of refund granted to me on this account along with interest. Deponent Verification I verify that the above information and its enclosures (if any) are true and correct to the best of my knowledge and belief and nothing has been concealed Place : Signature Date : Name : Status Instructions: 1. Please read the instructions carefully. 2. All the entries should be filled in capital letters. 3. Tick 9 applicable in option boxes. 4. The application should be filed in duplicate. 5. Enclose the following : a. Attested copy of declaration form VAT-15 or Form H in case of exports u/s 5(3) of CST Act. b. Certified copy of air consignment note / bill of lading / railway receipt or goods vehicle or postal receipt or any other documents in proof of export of goods across the customs frontier of India; duly authenticated by Customs Department. c. Duplicate copy of Sale Invoice. d. Certified copy(ies) of purchase invoice on the basis of which refund of ITC is claimed. e. Undertaking in prescribed form. f. Certificate from a Chartered Accountant regarding purchase and sale of goods and correctness of claim of refund (in Form VAT-26). 6. This Form should be verified and signed by: a. Proprietor, in case of Proprietorship concern. b. Managing Partner, in case of Partnership firm and where there is no Managing Partner, by all the partners if there is no registered partnership deed and in case of a registered partnership deed by any one of them. c. Managing Director or authorized signatory, in case of a Company. d. Karta, in case of Hindu Undivided Family. e. Authorised Signatory, in all other cases. f. Or by the declared Business Manager." 317
