Application Form For Issue Of Declarations In Form ST - 1/ST - 35/C/F/ Forms 

To

Assessing Authority

Ward No.

_______
   
_______
(1) Name and style of the business 
(2) Full Address :
(3) Local R.C. No. :/Autharisation No.
                   
                           
(4) No. of un-utilised forms in hand :
(5) No. of forms now required :
(6) Return period quarterly/monthly :
(7) The period/year upto which the assessment has been last made :
(8) Whether all returns due till date since the last assessment have been furnished and the tax due according to them paid ? If not, state the defaults and reasons thereof :
(9) Whether any amount of arrears of tax still remains payable? If so, state the year and the amount of arrears and reasons for non-payment.


I do hereby solemnly affirm and declare that the above information is true and correct to the best of my knowledge and belief.
Signature of the Dealer _______________
Status _______________

 

Please deliver __________________ forms of Shri __________________ an employee of my firm. His signatures are attested below :
Signature of Shri __________________
Signature Attested
Signature ____________________ Signature of Dealer ____________________
FOR OFFICIAL USE
(1)Signature of the applicant tally/do not tally with these on record.
(2)Verified that the dealer has filed all returns up-to-date. If not, mention defaults.
(3) Arrears due,, if any: Year Amount Local or Central Remarks
(4) If there is any other material or information which, according to law, could withholding of forms or issue of lesser number, give particulars.

Signature of the concerned Official(s) __________________
Order of Assessing Authority Signature of assessing authority

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