Commercial Tax Department FORM -R STATEMENT OF TAX DEDUCTION AT SOURCE (See rule 30(2)) To The Assessing Authority, ............ I, ............. son of ............ (here enter the status /designation) on behalf of Tvl. ...... ...... ...... .. ............... (here enter the name with correct and complete address of the person making deduction) hereby remit Rs. ....( Rupees ............. .....only) by way of Value Added Tax on works contract as per the details given below : - 1. Name of the dealer ... 2. Complete address of the registered place of business, if the dealer is registered dealer ... 3. Registration No. (TIN) under the Puducherry Value Added Tax Ordinance, 2007 ... 4. Complete address of the place of business / residence, if the dealer is not a registered dealer ... 5. Nature of the works contract entrusted (Copy of the work order should be furnished) ... 6. Date of agreement ... 7. Period of contract ... 8. Total value of the works contract entrusted Rs. ... 9. Bill No. with date as claimed by the Dealer (If the payment is advance amount/part payment, it should be specifically stated) ... 10. Total value of the bill passed for payment out of column 8 above ... Rs. 11. Percentage of tax deducted .... 12. Amount of tax deducted .... Rs. 13. Details of payment .. 14. Remarks ... I do hereby declare that the particulars furnished above are true and correct to the best of my knowledge and belief. Signature Date Name and Designation / Status and Station Relationship to the dealer with seal: NOTE : -1. The Statement shall be filed in duplicate and acknowledgement obtained for the delivery. 2. Separate statement shall be filed for each Contractor. 3. The remittance shall be to the assessing authority, by Bankers' cheque or Demand Draft drawn in favour of the assessing authority concerned. ACKNOWLEDGEMENT Received the statement with Cheque/Demand Draft/No. ........ dated ..... drawn on ............ . Place : Assessing Authority Date : Original : (Seal) Duplicate : Triplicate :
