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FORM - XXVIDepartment of Commercial Taxes, Government of Uttar Pradesh
[See Rule-45(7) of the UPVAT Rules, 2008 and Section 24 (7) & 26 of the UPVAT Act, 2008]Acknowledgement and self assessment of Annual Tax under Section 26 of the UPVAT Act, 2008
3-
4-
5-6-7-8-9-10-11-12-13-14-15-16-17-18-19-20-21-22-23-24-25-26-27-
Name of the dealer-
Receipt No. and date
Name and designation of official of the DCT
FORM - XXVIDepartment of Commercial Taxes, Government of Uttar Pradesh
[See Rule-45(7) of the UPVAT Rules, 2008 and Section 24 (7) & 26 of the UPVAT Act, 2008]Annual Tax Return
1- Assessment Year
2- Assessment Period beginning from
Date -
Place -
ToThe Assessing Authority
Corporate circle/Sector…………………… District …………………………Sir,
I ------------------------------------------------- s/o,d/o,w/o ------------------------------- (status) --------------------------------- of
M/s ………………………………………………………………………… ........................................................ hereby,
submit the Annual Tax Return and furnish the particulars of business as follows :
1. Assessmen
2. Assessmen
Ending on
3.
4. Taxpayer's Identification Number [TIN]
6. S.N.
i ii iii
7.
S.N.iiiiiiivvviviiviiiixxxixii
- Annex the detail information in annexures (I - VII) whichever applicable
Inventories of Opening & Closing Stock, Purchase & Otherwise Receipts, Manufacturing and Sales of Goods inAnnexure (VIII to X)
9(a). Details of purchase (other than works contract and transfer of right to use of any goods)
5. Entitlement certificate no./date
S.N.
i-ii-iii-iv-
v- vi-vii-
viii-
ix-ix-
Note: Reason to be given if the details of the purchases given here defer from those given in monthly and quarterly return
9(b). Computation of Tax on the turn over of purchase made from person other than registered dealer
S.N.i-
ii-iii-iv-v-vi-etc
10(a). Details of sales (other than works contract and transfer of right to use of any goods)
S.N.
i-ii-
iii-iii(a)iii(b)iii(c)Note: Reason to be given if the details of the sales given here defer from those given in monthly and quarterly return
10(b).S.N.
i-ii-iii-iv-v-vi-etc.
11- Total tax payableS.N.
iiiiiiiv
vviviiviiiix
12-
S.N.
i-
ii-
iii-
iv-
v-
vi-
vii-
viii-
ix-
x-xi-
xii-
1-S.N. i ii
2-S.N. i
ii
14(a)- Details of deposit along with return of tax period in Treasury/Bank
13- Information regarding search & seizure:-
S.N.1
1-2-3-4-5-6-7-8-9-10-11-12-
14(b) -
S.N.
Page 4 of 14
14(c) - Details of TDS in Form XXXIS.N.
15 - Computation of Net tax payableS.N.1-2-3-4-5-6-7-8-
DECLARATION
I……………………………….S/o,D/o,W/o/………………………………………Status……………………….[i.e. proprietor, director, partner etc. as provided in rule-32(6)], do hereby declare and verify that, all the statements andfigures given in this return are true and complete to the best of my knowledge and belief and nothing has been willfullyomitted, suppressed or wrongly stated.
Name of the dealer-Note:- 1-This Return must be signed by a person who is authorized under rule 32 (6) of Uttar Pradesh Value Added Tax Rules, 20082-if space provided in any table is insufficient the information may be submitted in prescribed format on separate sheet.
Department of Commercial Taxes, Government of Uttar Pradesh
Detail of Transport Memo in Form XXI received from the Department of Commercial Taxes and used in the assessment year
S. N.
Department of Commercial Taxes, Government of Uttar Pradesh
Details of Declaration (Form XXXVIII) received from the Department of Commercial Taxes and used during the assessment year
S. N.
1
Department of Commercial Taxes, Government of Uttar Pradesh
Details of declaration in Form C prescribed under The Central Sales Tax Act 1956 and used during assessment year
Date -
Place -
UPVAT - XXVI Annexure I
UPVAT - XXVI Annexure II
UPVAT - XXVI Annexure III
S. N.
1
Total declaration used =
Department of Commercial Taxes, Government of Uttar Pradesh
Details of Form EI prescribed under the Central Sales Tax Act, 1956 used during assessment year
S. N.
1
Total certificate used - ==
Department of Commercial Taxes, Government of Uttar Pradesh
Details of Form E-II prescribed under the Central Sales Tax Act, 1956 and used during assessment year
S. N.
1
UPVAT - XXVI Annexure IV
UPVAT XXVI Annexure V
Total declaration used - ==
Department of Commercial Taxes, Government of Uttar Pradesh
Details of Certificate in Form H prescribed under the Central Sales Tax Act, 1956 and used during assessment year
S. N.
1
Total certificates used - ==
Department of Commercial Taxes, Government of Uttar Pradesh
Details of declaration Form "F" used during assessment year
UPVAT - XXVI Annexure VI
UPVAT - XXVI Annexure VII
S. N.
1
Department of Commercial Taxes, Government of Uttar Pradesh
Tally of the goods in trading
S. N.
1
Department of Commercial Taxes, Government of Uttar Pradesh
Quantitative tally of the goods in manufacturing/processing/packing
S. N.
1
UPVAT - XXVI Annexure VIII
UPVAT - XXVI Annexure VIIIA
Department of Commercial Taxes, Government of Uttar Pradesh
UPVAT - XXVI
Inventories of the closing stock (in same form and condition)
Annexure IX
S.N.
11-2-3-etc
Department of Commercial Taxes, Government of Uttar Pradesh
UPVAT - XXVI
Inventories of the closing stock (finished / semi finished / waste / by product etc.) for manufacturer
Annexure X
S.N.1
1-2-3-etc
Department of Commercial Taxes, Government of Uttar PradeshUPVAT - XXVI
List of Certificate in Form 'D', received from purchasing dealer, for claiming reduction or exemption from the rate of tax
Annexure XI
S.N.
1
Department of Commercial Taxes, Government of Uttar Pradesh
List of sales return
S. N.
1
Department of Commercial Taxes, Government of Uttar Pradesh
Computation of ITC in case of taxable goods other than non vat goods andcapital goods, purchased within UP and sold in same form and condition
S.N.
1
Note: - If space provided is not sufficient the information is to be submitted in the above format separately
Department of Commercial Taxes, Government of Uttar Pradesh
UPVAT - XXVI
Computation of ITC in case of taxable goods other than non vat goods and capital goods,purchased within UP and used in manufacturing/processing/packing of vat goods
Annexure XIV
S.N.
UPVAT - XXVI Annexure XII
UPVAT - XXVI Annexure XIII
S.N.
1
Department of Commercial Taxes, Government of Uttar PradeshUPVAT - XXVI
Computation of RITC where taxable goods other than non vat goods and capital goods are disposed ofotherwise than by way of sale
Annexure XV
S.N.
1
Department of Commercial Taxes, Government of Uttar Pradesh
Computation of RITC where manufactured/processed/packed taxable goods other than non vatgoods and capital goods are disposed of otherwise than by way of sale
S.N.
UPVAT - XXVI Annexure XVI
S.N.
1
1-2-3-
Department of Commercial Taxes, Government of Uttar Pradesh
ITC on capital goods (only in case of manufacturer)
S.N.
1
Department of Commercial Taxes, Government of Uttar Pradesh
RITC on capital goods (only in case of manufacturer)
S.N.
1
UPVAT - XXVI Annexure XVII
UPVAT - XXVI Annexure XVIII
Department of Commercial Taxes, Government of Uttar Pradesh
Computation of ITC earned during the assessment year
S. N.
11-2-3-4-
5-6-7-8-9-10-11-12-13-14-15-
UPVAT - XXVI Annexure XIX
FORM - XXVIDepartment of Commercial Taxes, Government of Uttar Pradesh
[See Rule-45(7) of the UPVAT Rules, 2008 and Section 24 (7) & 26 of the UPVAT Act, 2008]Acknowledgement and self assessment of Annual Tax under Section 26 of the UPVAT Act, 2008
Name / Address of the dealer
Taxpayer's Identification Number [TIN]Entitlement Certificate No.Gross turnover of salesNet turnover of salesGross turnover of purchaseNet turnover of purchaseTax payable on net salesTax payable on net purchaseTaxable turnover of sale in case of transfer of right to use of goodsTax payable in case of transfer of right to use of goodsTotal tax payable (9+ 10+12)ITC brought from last yearITC earned during the yearTotal ITC (14+15)ITC adjusted against UPVATITC adjusted against CSTITC adjusted against UPTTTotal (17+18+19)Net tax payableTax paid by deposit in TreasuryBy adjustment from refundTDS (Certificate XXXI)Total deposit (22+23+24)Refund/DemandTDS as contractee
Name of the dealer-
Receipt No. and date
Name and designation of official of the DCT
FORM - XXVIDepartment of Commercial Taxes, Government of Uttar Pradesh
[See Rule-45(7) of the UPVAT Rules, 2008 and Section 24 (7) & 26 of the UPVAT Act, 2008]Annual Tax Return
1- Assessment Year 2 0 - 2 0
2- Assessment Period beginning from D D M M Y Y Ending on D D M M Y Y
Date - Name and Signature of partners/proprietor/karta etc.
Place - Status -
The Assessing Authority
Corporate circle/Sector…………………… District …………………………
I ------------------------------------------------- s/o,d/o,w/o ------------------------------- (status) --------------------------------- of
M/s ………………………………………………………………………… ........................................................ hereby,
submit the Annual Tax Return and furnish the particulars of business as follows :
2 0 2 0
d d m m y y
d d m m y
Name / Address of the dealer
4. Taxpayer's Identification Number [TIN]
Details of Bank AccountsName & address of the branch
Details of declaration or certificate received from Department of Commercial Taxes-
Name of FormXXIXXXIXXXVIIICFHEIEIIDIJAny other Form
- Annex the detail information in annexures (I - VII) whichever applicable
Inventories of Opening & Closing Stock, Purchase & Otherwise Receipts, Manufacturing and Sales of Goods inAnnexure (VIII to X)
9(a). Details of purchase (other than works contract and transfer of right to use of any goods)
5. Entitlement certificate no./date / d d m m y y
Particular of purchase
From registered dealer in UPFrom person other than registered dealer in UPIn the course of importIn the course of exportIn the course of movement of goods from one state to another by transfer of documents of titleIn the course of inter-state trade or commerceIn Ex-UP principal's A/CIn UP principal's A/C
Capital goodsAny other purchase for any purpose
Note: Reason to be given if the details of the purchases given here defer from those given in monthly and quarterly return
9(b). Computation of Tax on the turn over of purchase made from person other than registered dealer
Name of commodity
10(a). Details of sales (other than works contract and transfer of right to use of any goods)
Particular of sales
Gross saleGross central saleGross sales within the State(i-ii)To registered dealer in UP against form DTo registered dealer without form DTo person other than registered dealer in UP
Note: Reason to be given if the details of the sales given here defer from those given in monthly and quarterly return
Computation of Tax on the turn over of sales (other than works contract and transfer of right to use of any goods)Name of commodity
11- Total tax payableParticulars
On the turn over of purchaseOn the turnover of saleTax on transfer of right to use any goodsAmount of tax deducted at source
Tax under CST Act 1956Tax payable in case of works contract as per form XXVI BTax deposited by selling / purchasing commission agent for which Form V & VI has been obtained.Any other taxTotal tax payable
Details of ITC
Particular
ITC brought forward from the previous assessment year
ITC earned during the assessment year
Total (i+ii)
ITC adjusted against tax payable under CST Act for the current year
ITC adjusted against tax payable under UPVAT Act for the current year
ITC adjusted against dues in UPTT Act
ITC adjusted against any other dues
ITC refunded under section 41 if any
ITC refunded under section15(other than that of section 41)
Total (iv+v+vi+vii+viii+ix)ITC in balance (iii- x)
ITC carried forward for the next year
Detail of search, inspection and seizure in this Year, preceding Year and succeeding Year (If any) which are related to this year.
Date of search / inspection / seizure
Details of penalty/provisional assessment etc. and result in appeal/writDate of order
14(a)- Details of deposit along with return of tax period in Treasury/Bank
13- Information regarding search & seizure:-
Month2
AprilMayJuneJulyAugSeptOctoNovDecJanFebMarTotal
Details of adjustments in Form XXXIII-A
Month in which adjusted
14(c) - Details of TDS in Form XXXIName and address of the Contractee
15 - Computation of Net tax payableParticulars
Total amount of tax payableAdjustment of ITC against tax payableNet tax payable(1-2)Tax deposited in bankTax deposited by way adjustmentTax deposited by way TDSTotal( 4+5+6)Balance tax payable(3-7)
DECLARATION
I……………………………….S/o,D/o,W/o/………………………………………Status……………………….[i.e. proprietor, director, partner etc. as provided in rule-32(6)], do hereby declare and verify that, all the statements andfigures given in this return are true and complete to the best of my knowledge and belief and nothing has been willfullyomitted, suppressed or wrongly stated.
Name of the dealer-Note:- 1-This Return must be signed by a person who is authorized under rule 32 (6) of Uttar Pradesh Value Added Tax Rules, 20082-if space provided in any table is insufficient the information may be submitted in prescribed format on separate sheet.
Department of Commercial Taxes, Government of Uttar Pradesh
Detail of Transport Memo in Form XXI received from the Department of Commercial Taxes and used in the assessment year
Form No.
Total
Department of Commercial Taxes, Government of Uttar Pradesh
Details of Declaration (Form XXXVIII) received from the Department of Commercial Taxes and used during the assessment year
Number of declaration (Form XXXVIII)
2
Department of Commercial Taxes, Government of Uttar Pradesh
Details of declaration in Form C prescribed under The Central Sales Tax Act 1956 and used during assessment year
Date - Name and Signature of partners/proprietor/karta etc.
Place - Status -
UPVAT - XXVI Annexure I
UPVAT - XXVI Annexure II
UPVAT - XXVI Annexure III
Declaration No.
2
Total declaration used =
Department of Commercial Taxes, Government of Uttar Pradesh
Details of Form EI prescribed under the Central Sales Tax Act, 1956 used during assessment year
Form No.
2
Total certificate used - ==
Department of Commercial Taxes, Government of Uttar Pradesh
Details of Form E-II prescribed under the Central Sales Tax Act, 1956 and used during assessment year
Form No.
2
UPVAT - XXVI Annexure IV
UPVAT XXVI Annexure V
Total declaration used - ==
Department of Commercial Taxes, Government of Uttar Pradesh
Details of Certificate in Form H prescribed under the Central Sales Tax Act, 1956 and used during assessment year
Certificat e No.
2
Total certificates used - ==
Department of Commercial Taxes, Government of Uttar Pradesh
Details of declaration Form "F" used during assessment year
UPVAT - XXVI Annexure VI
UPVAT - XXVI Annexure VII
Declaration No.
2
Department of Commercial Taxes, Government of Uttar Pradesh
Tally of the goods in trading
Opening Stock
Name of the Commodity According to rate of tax
2
Total
Department of Commercial Taxes, Government of Uttar Pradesh
Quantitative tally of the goods in manufacturing/processing/packing
Opening StockName of the Commodity According to rate of tax
2
UPVAT - XXVI Annexure VIII
UPVAT - XXVI Annexure VIIIA
Total
Department of Commercial Taxes, Government of Uttar Pradesh
UPVAT - XXVI
Inventories of the closing stock (in same form and condition)
Annexure IX
Name of the Commodity According to rate of tax
2
Total
Department of Commercial Taxes, Government of Uttar Pradesh
UPVAT - XXVI
Inventories of the closing stock (finished / semi finished / waste / by product etc.) for manufacturer
Annexure X
Name of the commodity2
Total
Department of Commercial Taxes, Government of Uttar PradeshUPVAT - XXVI
List of Certificate in Form 'D', received from purchasing dealer, for claiming reduction or exemption from the rate of tax
Annexure XI
Name and address of the purchasing dealer
2
Department of Commercial Taxes, Government of Uttar Pradesh
List of sales return
Name and address of the dealer to whom goods have been sold
2
Department of Commercial Taxes, Government of Uttar Pradesh
Computation of ITC in case of taxable goods other than non vat goods andcapital goods, purchased within UP and sold in same form and condition
Name of the Commodity according to rate of tax
2
Total
Note: - If space provided is not sufficient the information is to be submitted in the above format separately
Department of Commercial Taxes, Government of Uttar Pradesh
UPVAT - XXVI
Computation of ITC in case of taxable goods other than non vat goods and capital goods,purchased within UP and used in manufacturing/processing/packing of vat goods
Annexure XIV
Name of goods used in manufacturing/packing/ processing of goods in col.2
UPVAT - XXVI Annexure XII
UPVAT - XXVI Annexure XIII
2
Total
Department of Commercial Taxes, Government of Uttar PradeshUPVAT - XXVI
Computation of RITC where taxable goods other than non vat goods and capital goods are disposed ofotherwise than by way of sale
Annexure XV
Goods disposed of otherwise than by way of sale
Name2(a)
Department of Commercial Taxes, Government of Uttar Pradesh
Computation of RITC where manufactured/processed/packed taxable goods other than non vatgoods and capital goods are disposed of otherwise than by way of sale
Name of the manufactured/pro cessed/packed vat goods
UPVAT - XXVI Annexure XVI
2
Total
Department of Commercial Taxes, Government of Uttar Pradesh
ITC on capital goods (only in case of manufacturer)
Description of goods
2
Total
Department of Commercial Taxes, Government of Uttar Pradesh
RITC on capital goods (only in case of manufacturer)
Description of goods
2
Total
UPVAT - XXVI Annexure XVII
UPVAT - XXVI Annexure XVIII
Department of Commercial Taxes, Government of Uttar Pradesh
Computation of ITC earned during the assessment year
Particular2
Amount of ITC as per Annexure XIIIAmount of ITC as per Annexure XIVInstallments of ITC on the stock held in the opening stock on the date of commencement of the Act
Installments of ITC on the closing stock on the date on which period of composition under section 6 terminatesInstallment of ITC in case of capital goods if anyAny other ITCTotal ITC (1+2+3+4+5+6+7)Amount of RITC as per Annexure XVIAmount of RITC as per Annexure XVIIAmount of RITC on the closing stock on the date of discontinuance of businessRITC on capital goodsAny other RITCTotal RITC (9+10+11+12+13)ITC earned(8-14)
UPVAT - XXVI Annexure XIX
Installments of ITC on the stock held in the opening stock on the date when the dealer becomes liable to tax after the commencement of the Act
FORM - XXVIDepartment of Commercial Taxes, Government of Uttar Pradesh
[See Rule-45(7) of the UPVAT Rules, 2008 and Section 24 (7) & 26 of the UPVAT Act, 2008]Acknowledgement and self assessment of Annual Tax under Section 26 of the UPVAT Act, 2008
-
FORM - XXVIDepartment of Commercial Taxes, Government of Uttar Pradesh
[See Rule-45(7) of the UPVAT Rules, 2008 and Section 24 (7) & 26 of the UPVAT Act, 2008]Annual Tax Return
-
Details of Bank AccountsNature of A Account No.
Opening Received Used Surrendered ClosingBalance No. No. Total No. BalanceNo. 5(a) 5(b) 6 Total No.
Amount Covered
lost/destroye
d
Purchase Rate of tax Amount of tax
Type of t Turnover of sal Rate of tax mount of tax
Amount
Purchase turnover of vat goods
Purchase turnover of non vat goods
Purchase turnover Exempt goods
Total turn over
Turnover of Vat goods
Turn over of non vat goods
Turn over of exempt goods
Total turn over
Amount
Name of Authority, who has conducted search & seizure
Result
Result in Appeals/writ, if pending write appeal/writ no.
TribunalSettlement Commissi
Section in which order is passed
Amount of penalty /tax
Ist AppealHigh Court/ Supreme Court
Amount TC no. Date Name of the Name and address of the Branch3 4 5 6 7
Amount
Amount
Year from which adjusted
Order no. and date in Form XXXIII-A
Contract no. and date
Amount of TDS
Printed No. of Form XXXI
TIN of consignee Bill/ Challan Date Amount
TIN Commodity
3 4 5 6 7 8 9
Name & address of Consignee
Description of goods
Quantity/Measure/ Weight
Name & address of the selling dealer or consignor
Tax/Sale invoice/
Date
Quantity/ Measure/ Weight as per Form XXXVIII
Amount as per Form XXXVIII
Amount as per tax/sale invoice
Commodity
3 4 5 6 7 8 9
Total Amount
Quantity/ measure
3 4 5 6 7 8 9
Total Amount
3 4 5 6 7 8
Name & address of the selling dealer
TIN of the selling dealer
Tax/Sale invoice no. and date
Quantity/ Measure/ Weight
Amount of tax/sale invoice
Assessment Year of purchase
Name & address (with state) of the purchasing
dealer
TIN of the purchasing dealer
Place and State in which
movement of goods
commenced
Place and State to
which the goods have
been consigned
Tax/Sale invoice no.
and date
Description of goods
Name & address (with state)
affecting a sale by transfer of
the document of title to the goods
Name & address (with state) of the purchasing dealer
TIN of the purchasing dealer
Name of the place and state in which movement commenced
Name of the place
and state to which the
goods have been
consigned
Tax/Sale invoice no.
and date
Description of goods
Total Amount
3 4 5 6 7 8 9
Total Amount
Name & address of the selling dealer
order no. and date of foreign buyer
TIN of the selling dealer
Descriptio n of goods
Tax/Sale invoice no.
and date
Quantity/ Measure/ Weight
Amount of tax/sale invoice in Rs.
/foreign currency
3 4 5 6 7 8 9
Department of Commercial Taxes, Government of Uttar Pradesh
ReceivedTotal Disposal otherwise
Value By Purchase Value Value Value Value Value
3 4 5 6 7 8 9
Department of Commercial Taxes, Government of Uttar Pradesh
Value Received
3 4 By Purchase Total
Value Value Quantity/ Measure
5 6 7 8 9
Name & address of consignor dealer
TIN of consignor and its effective date
Transfer invoice/ date
Descriptio n of goods
Quantity/ Measure/ Weight
Amount/ estimated amount
Name of airline/railway/good s vehicle or other means of transport through which goods have been received
By Stock Transfer or Otherwise
Sale/consumption
in manufacturin
g/ processing/pa
cking
Quantity/ Measure
By Stock Transfer or Otherwise
Quantity/ Measure
Quantity/ Measure
Department of Commercial Taxes, Government of Uttar Pradesh
3
Department of Commercial Taxes, Government of Uttar Pradesh
Quantity/ Measure of the Commodity in StockAmount3 4
Department of Commercial Taxes, Government of Uttar Pradesh
Amount of tax
3 4 5 6 7 8 9
Value of the commodity in
column 2
TIN and date of validity
Sale invoice no. and date
Description of goods
Measure/ Quantity
Sale amount in
Rs.
Rate of tax charged
TIN of the deale
3 4 5 6 7 8 9
Total input tax credit
Value of go Value of goods Tax paid to Treasury
3(a) 3(b) 4(a) 4(b) [3(b)+4(b)]3
Department of Commercial Taxes, Government of Uttar Pradesh
Description of the goods
Tax / Sale invoice and
Date
Quantity/ Measure of
goods return
Amount of goods
return
Amount of tax in
respect of goods return
Date of receipt of goods returned
Purchased from registered dealer against tax invoice
Purchased from person other than registered
Tax paid or payable
Purchased from registered dealer against tax invoice
Purchased from
person other than
3(a) 3(b) 3(c) 3(d) 3(e) 3(f) 3(c)+3(f))4
Department of Commercial Taxes, Government of Uttar Pradesh
2(b) 3 4 5 6
Measure / Quantity
Value of goods
Tax paid or payable to registered
dealer
Measure / Quantity
Value of goods
Tax paid to
Treasury
Total input tax credit
Purchase value exclusive of tax
Rate of tax payable under the Act
Amount of admissible
ITC
Amount of ITC claimed
Amount of reverse input tax credit (5-4)
Name
Purchase Amount of tax paid toRegistered dealer Treasury ITC on capital goods
3a 3b 4a 4b 5a 5b 5b
Purchase of capital goods Amount of tax paid to
Registered dealer Treasury Input tax
3a 3b 4a 4b 5a 5b 5c
Goods used in manufacturing/ processing/ packing of goods mentioned
in col.2
Quantity/Measure
Purchase value
exclusive of tax
Rate of tax payable under the
Admissible ITC
Amount of ITC claimed
Amount of reverse input tax credit (6-5)
Quantity/ Measure
Value excluding tax
Amount of input tax on capital
goods
Amount of installment
Disposal of capital goods otherwise than in capital goods
Quantity/ Measure
Value excluding tax
Quantity/ Measure
Value excluding tax
Amount3
Result
10
Reason for the difference if any (Attach proof )
10 11
Value of goods
10 11 12 13
Quantity/ measure Value of goods
9 10 11 12 13
S. no. of declaration Form XXXVIII issued
Reason of difference if any
GR/RR or other documents of other means of transport
Form C received from
purchasing dealer
Name of the State issuing
Form C
GR/RR or other document of
other means of transport
Declaration in Form C
received from the purchasing
dealer
Name of the State of issuing
Form C
10 11
Name of the airline /ship /railway /goods
vehicle or other means of transport through which the export has taken
place
No. and date of air consignment note/bill of lading/railway receipt or goods vehicle record or
postal receipt or any other document in proof of
export of goods across the customs frontier of
India
Closing stock
Value
10
Sale/consumption in Disposal otherwise Closing stock
Value Quantity/ Measure Value Value Value
10 11 12 13 14 15 16
No. and date of air consignment note/ railway receipt or goods vehicle record or postal receipt or any other document in proof of receipt of goods
manufacturing/ processing/packing
Quantity/ Measure
Quantity/ Measure
Total Amount
10 11
Printed No. of Form 'D'
Amount of RITC Amount of installment
6b 5b