Form VAT - 25 [See Rule 27 (1)(b)& 28(3)] Refund Adjustment Order Book No........................ Voucher No............... XII A VAT Deduct Refund 1. Name of Dealer (Proprietor/Firm ______________________________________________ name/Company name etc.) 2. Trade Name (s) (if any) ______________________________________________ (in which the business is carried on) 3. Registrations No. (TIN) _____________________________________________ 4. Address Building No/ Name/ Area _____________________________________________ Town/City _____________________________________________ District (State) _____________________________________________ Pin Code _____________________________________________ Email Id _____________________________________________ Telephone Number(s) _____________________________________________ Fax Number(s) _____________________________________________ 5. Period of refund _____________________________________________ 6. Amount of refund to be adjusted ______________________________________________ in figures in words ______________________________________________ 7. Certified that no refund order regarding the sum in question has previously been granted and this order of refund has been entered on the original assessment order and the demand and collection register. 8. Certified that the tax, penalty or interest concerning which this refund is allowed has been credited into the Treasury / Bank................. under challan No .................. dated ............ 9. This refund will be adjusted towards the amount of VAT/CST/Other dues from the said dealer for the period from......................to.......................or any subsequent month/quarter/year in the future. Signature (Seal) Name Designation Place : __________________ Date: ___________________ Note:-The dealer shall enclose this Order with the return to be furnished by him for the month/quarter/year........................against which the adjustment is desired.
