VAT - 16 [See Rule 21(3) ] Application for obtaining declaration forms To, 1. Name of Dealer 2. Address Bldg. No/Name/Area Town/City District (State) Pin Code Telephone Number(s) 4. 5. 6. Details of Challan / receipt in support of deposit of requisite fee. Declaration I/We declare that my / our Registration Certificate mentioned above is in force and has not been cancelled by this date. I/We further declare that (a) I/We have properly used the declaration forms issued to me/us in the past (List be enclosed) (b) I/We have no demand outstanding to be payable by me/us; (c) I/We have submitted my/our all due returns along with necessary enclosures; (d) I/We have deposited the due tax till date; and (e) I/We have furnished necessary security as demanded by the assessing authority. I/We authorise Shri ________________________________________ my/our authorised representative, whose signature is attested below, to receive the said forms on my/our behalf. us Place : Signature Date : Name : Status Verification I verify that the information given in this form and its attachments (if any) is 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 . applicable in option boxes 4. Enclose proof of payment of requisite fees 5. 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 any other Partner 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
