FORM VAT-36 [See Rule 37(2)] Certificate of the Sale Proceeds by the Commission Agent to the Principal Serial No._______________________ Counterfoil / Original / Duplicate Details of the Principal: 1. Name of the Dealer ___________________________________________________ ___________________________________________________ 2. Registration No. (TIN) ___________________________________________________ 3. Address Building No./ Name / Area ______________________________________ Area / Road ______________________________________ Locality / Market ______________________________________ Pin Code ______________________________________ Email Id ______________________________________ Telephone Number (s) ______________________________________ Fax Number (s) ______________________________________ 4. Description of the goods sold by Agent: VAT Invoice Name of the goods Goods Received vide VAT 36 Qt/No. of bags or packages Weight Rate per unit Amount Rs. Expenses Rs. No. Date No. Date (1) Freight (2) Gaushala (3) Shifting Charges (4) Weighing Charges (5) Delivery Charges (7) Labour Charges (7) Cartage (8) Other Charges Total: Commission: Grand Total: Enclosures :-(1) Part IV of Challan of Tax deposited (2) Duplicate Copy of VAT invoice Signature Name Status Place Date Verification I verify that the information given on this form and on its attachments is true and correct to the best of my knowledge and belief and nothing has been concealed. Signature Name Status Place Date
