Vat Return (1st) Qtr)

LIST OF SALE OF GOODS IN THE COURSE OF INTERESTATE TRADE AND COMMERCE FOR THE QUARTER ENDED

Name and TIN of the VAT dealer furnishing the list

Name and style of businessD D M M Y

3 0 0 6 2 0 1TIN 0 6 0 7 1 8 2 8 3 1 8 Economic activity code

Name and address of the Purchaser TIN Sale/Invoice No./ Date Description of goods Quantity / Weight Value of Goods Value of Goods

1 2 3 4 5 6 7 8

1

28310167509

Pine Apple Syrup

100 Kg

24,600.00 24,600.00

2

27110410052

Alphanso Mango Pulp

148.80 Kg

10,713.60 10,713.60

3

23629010554

Strawberry Fruit Preparation

175 Kg

35,875.00 35,875.00

4

33591121863 64 Bottles

16,750.00 16,750.00

5

08720600732

Apple Flavour, Apple Flavour,

80 Kg

390,000.00 390,000.00

6

24571600064

Mango Concentrate, Strawberry Concentrate

431 Kg

177,440.00 177,440.00

7

CST No. 20254430 Banana Strawberry Crush, 24 Bottle

7,059.00 7,059.00

FORM LS-2(See VAT-R1

Orana India Pvt. Ltd GP-28, 3rd Floor,

Sector-18, Gurgaon Haryana, PIN 122015

Sr.

No.

Sold against declaration

of form "C"

Sold without

declaration in

form "C"

Heritage Foods (India) Ltd., 001: Head Office 6-3-541/C, Panjagutta, Hyderabad

- 500082

OIN/INV/2011/I097

dated 05/04/2011

Schreiber Dynamix Dairies Ltd. , E-94, M.I.D.C, Bhigwan Road, Baramati - 413133,

Pune - Maharashtra

OIN/INV/2011/I098

dated 05/04/2011

AVM Foods Spacialities, 396, Cleark Colony, Indore - 452011, Madhya Pradesh

OIN/INV/2011/I099

dated 05/04/2011

Anp Associate,#25 Gajapathy Street, Ground Floor, Shnoy Nagar, Chennai - 600030

OIN/INV/2011/I100

dated 06/04/2011

Pinnacolada Syrup, Strawberry Green Tea Syrup, Lychee Green Tea Syrup, Cherry Crush, Strawberry Crush,Forest Fruit Crush, Kiwi Crush, Muskmelon Crush, Pink Guava Crush

Dabur India Ltd., Plot No. G- 50-59, Road No.1, II D Centre, National Highway No.12, Newai-304020-

Rajasthan

OIN/INV/2011/I101

dated 07/04/2011

M/s Mother Dairy , A unit of Gujrat Co-operative, Plot no - 35, Near Indira Bridge

OIN/INV/2011/I102

dated 11/04/2011

Amalgamated Bean Coffee Trading Co. Ltd., Café Coffee Day - Divison, SCM-HQ, #5,II

Cross, PM Ind Area, NS Palya, Bangalore - 560076

OIN/INV/2011/I103

dated 12/04/2011

8

CST No. 20254430

Black Currant Crush

240 Bottle

69,048.00 69,048.00

9

9537 DTD 15.10.2005

Black Currant Syrup

138 Bottle

49,693.80 49,693.80

29910870135 60 Bottle

17,610.00 17,610.00

10

Black Currant Crush,Kiwi Crush

264 Bottle

75,912.00 75,912.00

11

Banana Strawberry Crush, Peach Crush

48 Bottle

14,588.00 14,588.00

12

29270836246

Peach Green Tea Syrup

55 Kg

9,471.00 9,471.00

13

29270836246

Lychee Green Tea Syrup

31.20 Kg

5414.00 5,414.00

14

29910870135 60 Bottle

17,610.00 17,610.00

15

29910870135

Banana Strawberry Crush, Black Currant crush

36 Bottle

11,580.00 11,580.00

16

27410138869C 180 Bottles

47,100.00 47,100.00

17

33591121863 114 Bottle

30,180.00 30,180.00



OIN/INV/2011/I104

dated 12/04/2011

Devyani Food Industries Pvt. Ltd. Plot no - 1-21, EPIP Phase - 2, Village Thana, Baddi,

Tehsil - Nalagarh, Dist, Solan

OIN/INV/2011/I105

dated 12/04/2011

Future Value retail Ltd. Big Bazzar, Bangalore Central - 3, Soul Space Sprit, bangalore Outer

Ring road, Bellandur Village Varthur Hobil, Bangalore - 56003

OIN/INV/2011/I106

dated 12/04/2011

Forest Fruit Crush, Kiwi Crush, Pink Guava

Crush, Strawberry Crush, Muskmelon Crush

Amalgamated Bean Coffee Trading Co. Ltd C/O TCI Logistics, A - 25, Phase 1, Okhla

Industrial Area, New Delhi

CST No. 07120245040

OIN/INV/2011/I107

dated 12/04/2011



CST No. 07120245040

OIN/INV/2011/I108

dated 12/04/2011

Au Bon Pain Café India Ltd. No.67/4, Yeshwantpur Industrial Suburbs, Near Ullas

Theater, Bangalore- 560022

OIN/INV/2011/I109

dated 12/04/2011



OIN/INV/2011/I10

dated 12/04/2011



OIN/INV/2011/I111

dated 12/04/2011

Forest Fruit Crush, Kiwi Crush, Pink Guava

Crush, Strawberry Crush, Muskmelon Crush



OIN/INV/2011/I112

dated 12/04/2011

Trinity Enterprises, Building no - 29, A-405, Tilak Nagar, Chember, Mumbai - 400089

OIN/INV/2011/I113

dated 12/04/2011

Lemon Green Tea Syrup, Peach Green Tea Syrup, Green Apple Syrup, Passion Fruit Syrup, Pinnacolada Syrup, Strawberry Syrup, Pink Guava Crush, Strawberry Crush


OIN/INV/2011/I114

dated 12/04/2011

Green Apple Syup, Passion Fruit Syrup, Black

Currant syrup, Strawberry syrup, Strawberry

crush,Forest Fruit Crush, Kiwi Crush,

Muskmelon Crush, Pink Guava Crush

18

24573601280

Muskmelon Crush

120 Bottle

36,000.00 36,000.00

19

29910870135 Banana Strawberry Crush, Black Currant crush 36 Bottle 11580

11,580.00

20

156 Bottle

41,760.00 41,760.00

21

29270836246 187.20 Kg

32,470.00 32,470.00

22

29910870135 24 Bottle

8,280.00 8,280.00

23

27410138869C

Green Apple Crush

48 Bottle

14,400.00 14,400.00

24

29910870135 24 Bottle

8,280.00 8280

33591121863

Green Apple Crush, Cherry Crush

24 Bottle

7,440.00 7,440.00

25

12235207575

Raspberry Filling

81.60 Kg

21,216.00 21,216.00

07310344603

282 Bottles 67248 67,248.00

Rita Enterprises, H-33 Parshwanath Tower, Subhah Chowk, Gurukul Road, Ahmedabad -

380052

OIN/INV/2011/I115

dated 12/04/2011



OIN/INV/2011/I116

dated 12/04/2011

M.K. Sales SCO - 90, Basement, Sector - 44C, Chandigarh

OIN/INV/2011/I117

dated 12/04/2011

Black Currant Syrup, Green Apple Syrup, Passion Furit Syrup, Strawberry Syrup, Lychee Green Tea Syrup, Peach Green Tea Syrup,Black Currant Crush, Strawberry Crush



OIN/INV/2011/I118

dated 14/04/2011Lychee Green Tea Syrup, Peach Green Tea Syrup



OIN/INV/2011/I121

dated 15/04/2011Cherry Crush, Green Apple Crush, Mixec Berry Cursh


OIN/INV/2011/I122

dated 15/04/2011



OIN/INV/2011/I123

dated 15/04/2011Cherry Crush, Green Apple Crush, Mixec Berry Cursh


OIN/INV/2011/I124

dated 15/04/2011

Tropilite Foods Pvt. Ltd. Davar Campus, Industrial Area, Tansen, Gwalior - 474002

(M.P.)

OIN/INV/2011/I125

dated 19/04/2011

Mekail Trading Company Pvt Ltd. 19-A, New Colony Model Basti, karol Bagh,

Delhi - 110005

OIN/INV/2011/I126

dated 19/04/2011

Green Apple Syrup, Passion Fruit

Syrup,Pinnacolada Syrup,Black Currant Syrup,

Pink Guava Crush, Forest Fruit Crush

26

27410138869C 298 Bottles

74,210.00 74,210.00

27

28240993919

Muskmelon Crush, Pink Guava Crush

30 Bottles

8,760.00 8,760.00

28 Green apple Crush, Forest Fruit crush

18 Bottles

4,980.00 4,980.00

29 Black Currant Crush

47 Bottles

80,843.70 80,843.70

30

270 Bottles

78,846.60 78,846.60

31

CST No. 20254430

Black Currant Crush

360 Bottles

103,572.00 103,572.00

CST No. 20254430

Banana Strawberry Crush, Kiwi Crush

62 Bottles

20,982.00 20,982.00

32

Black Currant Crush 240 Bottles

69,048.00 69,048.00

33

33591121863

Green Apple Crush, Musk Melon Crush

30 Bottles

9,300.00 9,300.00

34

33591121863 48 Bottle

10,200.00 10,200.00


OIN/INV/2011/I129

dated 25/04/2011

Lemon Green Tea Syrup, Lychee Green Tea Syrup, Peach Green Tea Syrup,Strawberry Green Tea Syrup, Green Apple Syrup, Passion Fruit Syrup, Pinnacolada Syrup, Strawberry Syrup, Pink Guava Crush,Forest Fruit Crush, Musk Melon Crush

Trupti Food and Beverages, 3-6-271, Sudheer tapani towes, Himalayanagar Main Road, Beside Punjab National Bank, Hydrabad -

500028

OIN/INV/2011/I130

dated 28/04/2011

Sachin Chawla 1982, Outram Lane, Kingsway Camp, Delhi - 110006

OIN/INV/2011/I131

dated 03/05/2011



CST No. 07120245040

OIN/INV/2011/I134

dated 05/05/2011



CST No. 07120245040

OIN/INV/2011/I135

dated 05/05/2011

Black Currant Crush, Banana Strawberry

Crush,Peach Crush



OIN/INV/2011/I136

dated 05/05/2011



OIN/INV/2011/I137

dated 05/05/2011

Amalgamated Bean Coffee Trading Co. Ltd., Café Coffee Day - Divison, SCM-REG, Central

Mumbai, MD-1 &2, Gupta Warehousing Complex, Bhiwandi - 421302

CST No. 27720001492 C

OIN/INV/2011/I138

dated 05/05/2011


OIN/INV/2011/I139

dated 05/05/2011


OIN/INV/2011/I140

dated 05/05/2011Forest Fruit Crush, Peach Green Tea Syrup,Pink Guava crush

35

08720600732

Aronia Concentrate

2000 Kg

1,642,000.00 1,642,000.00

36

23964102489

Mixed Berry Concentrate

3300 Kg

1,056,000.00 1,056,000.00

37

23964102489

Orange Concentrate

5200 kg

1,190,800.00 1,190,800.00

38

08720600732

Pomegranate Juice Concentrate

2970 Kg

1,143,450.00 1,143,450.00

39

07710224685

Green Apple Crush

156 Bottle

23,400.00 23,400.00

40

29270836246 234 Kg

40,586.00 40,586.00

41

84 Bottles

20,700.00 20,700.00

42

27110410052

Strawberry Syrup

400 Kg

132,000.00 132,000.00

43

24573601280 108 Bottles

25,440.00 25,440.00

44

24573601280

Muskmelon Crush

60 Bottle

9,000.00 9,000.00

45

08720600732


11440 Kg

4,404,400.00 4,404,400.00


Rajasthan

OIN/INV/2011/I141

dated 09/05/2011

Godrej Hershey Ltd, Plot no. 5, New Industrial Area No. 1, Mandideep - 462046

OIN/INV/2011/I142

dated 09/05/2011

Godrej Hershey Ltd, Plot no. 5, New Industrial Area No. 1, Mandideep - 462046

OIN/INV/2011/I143

dated 09/05/2011


Rajasthan

OIN/INV/2011/I144

dated 09/05/2011

Barista Coffee Company Ltd.55 Community Center, Basant Lok Market, Vasant Vihar,

New Delhi - 110057

OIN/INV/2011/I145

dated 12/05/2011



OIN/INV/2011/I146

dated 12/05/2011Peach Green Tea Syrup, Lychee Green Tea Syrup

Kasturi Agro Foods & Marketing Pvt. Ltd. Plot no. 35, Shivaji Society, B/H Hotel

Marriott, Senapati Bepat Road, Pune - 411016

OIN/INV/2011/I147

dated 12/05/2011

Lemon Green Tea Syrup, Peach Green Tea

Syrup, Lychee Green Tea syrup, Green Apple

Syrup, Passion Fruit Syrup, Pinnacolada Syrup,

Black Currant Syrup, Forest Fruit Crush,

Muskmelon Crush


Pune - Maharashtra

OIN/INV/2011/I151

dated 16/05/2011


380052

OIN/INV/2011/I152

dated 18/05/2011Muskmelon Crush, Green Apple Crush, Forest Fruit Crush


380052

OIN/INV/2011/I153

dated 18/05/2011


Rajasthan

OIN/INV/2011/I154

dated 18/05/2011

46

Black currant Crush

120 Bottle

34,524.00 34,524.00

47

CST No. 20254430 Black Currant Crush 240 Bottles

69,048.00 69,048.00

48 Black Currant Crush

102 Bottles

29,345.00 29,345.00

49

04350014588 234 Bottles

53,100.00 53,100.00

50

27110410052 6825 Kg

931,950.00 931,950.00

51

02235207575

Dark Cherry Filling, red Cherry Filling

1922 Kg

500,216.00 500,216.00

52

CST No. 29740879686 2000 Kg

330,000.00 330,000.00

53

02876295129

Muskmelon Crush, Forest Fruit Crush

24 Bottles

7,320.00 7,320.00

54

27610646651

Strawberry Compound

10 Kg

4,700.00 4,700.00

55

27610646651 252 Bottles

59,550.00 59,550.00



CST No. 27720001492 C

OIN/INV/2011/I155

dated 23/05/2011



OIN/INV/2011/I156

dated 23/05/2011



CST No. 07120245040

OIN/INV/2011/I157

dated 23/05/2011

M.K. Sales, SCO - 90, Basement, Sector 44C, Chandigarh

OIN/INV/2011/I158

dated 23/05/2011

Lemon Green Tea Syrup,Apple Green Tea Syrup, strawberry Green tea Syrup,Green Apple Syrup, Passion Fruit Syrup, Strawberrry Syrup, Lychee Green Tea Syrup,Peach Green tea syrup, Green Apple Crush, Forest Fruit Crush, Kiwi Crush,Pink Guava Crush, Muskmelon Crush


Pune - Maharashtra

OIN/INV/2011/I161

dated 23/05/2011Strawberry Syrup, Strawberry Syrup, Mango Syrup


(M.P.)

OIN/INV/2011/I162

dated 23/05/2011

Shriram Distribution Services Pvt. Ltd. No. 14 & 15 Cross, Hosur Main Road, Behind the

State Bank of Mysore, Singasandra, Bangalore - 560068

OIN/INV/2011/I163

dated 23/05/2011Cranberry Compound, Passion of Guava Compound

lohiyo Agro tech India Pvt. Ltd, 7-4-246/95, BJR Nagar, Balkampet - 5600018, Hydrabad

OIN/INV/2011/I164

dated 23/05/2011

Pushpam Foods & Beverages Pvt Ltd, Gat No. 104/2A, Village - Barote Vasi(Nandur) -

Pune

OIN/INV/2011/I165

dated 25/05/2011

Strategic Marketing And Research Team, # 253, 67th Cross, 5th Block, Rajaji

Nagar,560010, Bangalore

OIN/INV/2011/I166

dated 25/05/2011

Green Apple Syrup, Strawberry Syrup, Pinacolada Syrup, passion Fruit Syrup, Peach green tea syrup, strawberry Green Tea Syrup, Lemon Green Tea Syrup, Apple Green Tea Syrup,Forest Fruit Crush, Pink Guava Crush, Muskmelon Crush, Green Apple Crush

56

CST No. 29740879686

Muskmelon Crush

180 Bottles

55,800.00 55,800.00

57 Muskmelon Crush

18 Bottles

2,700.00 2,700.00

58

09766101264

Orange Flavour

10 Kg

32,000.00 32,000.00

59 Green Apple Crush

30 Bottles

4,800.00 4,800.00

60

72 Bottle

16,740.00 16,740.00

61

08720600732

Aronia Concentrate

4000 Kg

3,284,000.00 3,284,000.00

62

07710224685

Green Apple Crush

300 Bottle

45,000.00 45,000.00

63

07710224685

Forest Fruit Crush

204 Bottles

35,700.00 35,700.00

64

CST No. 29740879686

Muskemelon Crush

150 Bottles

46,500.00 46,500.00

65

CST No. 20254430

Peach Crush, Kiwi Crush

84 Bottles

25,688.00 25,688.00



OIN/INV/2011/I167

dated 25/05/2011

M.K. Sales SCO - 90, Basement, Sector - 44C, Chandigarh

OIN/INV/2011/I168

dated 27/05/2011

Surya Fresh Foods Ltd., Unit - 1, Factory, Plot no - 14 Noida Dadri Road, Surajpur

Greater Noida (U.P.)

OIN/INV/2011/I169

dated 27/05/2011

Sachin Chawla 1982, Outram Lane, Kingsway Camp, Delhi - 110006

OIN/INV/2011/I170

dated 30/05/2011

Kasturi Agro Foods & Marketing Pvt. Ltd. Plot no. 35, Shivaji Society, B/H Hotel

Marriott, Senapati Bepat Road, Pune - 411016

OIN/INV/2011/I171

dated 30/05/2011

Apple Green Tea Syrup, Peach Green Tea

Syrup,Strawberry Green Tea syrup, Green

Apple Syrup, Passion Fruit Syrup, Green Apple

Crush, Kiwi Crush, Forest Fruit Crush, Pink

Guava Crush Muskmelon Crush


Rajasthan

OIN/INV/2011/I172

dated 02/06/2011


New Delhi - 110057

OIN/INV/2011/I173

dated 02/06/2011


New Delhi - 110057

OIN/INV/2011/I174

dated 02/06/2011



OIN/INV/2011/I175

dated 07/06/2011



OIN/INV/2011/I176

dated 09/06/2011

66

08720600732


11440 Kg

4,404,400.00 4,404,400.00

9537 DTD 15.10.2005

Black Currant Syrup

203 Kg

56,231.00 56,231.00

67

CST No. 20254430

Black Currant Crush

360 Bottles

103,572.00 103,572.00

68

27110410052

Strawberry Syrup, Mango Syrup

3750 Kg

512,250.00 512,250.00

69

12235207575

Strawberry Filling

983 Kg

196,680.00 196,680.00

70

07710224685

Forest Fruit Crush

120 Bottle

21,000.00 21,000.00

71

07710224685 126 Bottles

37,022.00 37,022.00

72

32071893625C 66 Bottles

17,700.00 17,700.00

73

29270836246 187 Kg

32,470.00 32,470.00

74

23031301495 84 Bottles

19,830.00 19,830.00


Rajasthan

OIN/INV/2011/I177

dated 10/06/2011



OIN/INV/2011/I178

dated 13/06/2011



OIN/INV/2011/I181

dated 14/06/2011


Pune - Maharashtra

OIN/INV/2011/I183

dated 14/06/2011


(M.P.)

OIN/INV/2011/I184

dated 14/06/2011


New Delhi - 110057

OIN/INV/2011/I185

dated 15/06/2011


New Delhi - 110057

OIN/INV/2011/I186

dated 16/06/2011Kiwi Crush, banana Strawberry Crush, Peach

Crush

As & Company, 39/6218 B - 3, Peru Estate, Kizhavana road, Atlantis, cochin 682015,

India

OIN/INV/2011/I187

dated 16/06/2011

Strawberry Green Tea, Lemon Green Tea Syrup, Apple Green Tea Syrup, Forest Fruit

Crush, Black Currant crush, Strawberry Crush, Pink Guava Crush, Muskmelon Crush, Green

Apple Crush



OIN/INV/2011/I188

dated 22/06/2011Peach Green Tea Syrup, Lychee Green Tea

Syrup

Bajaj Frozen Food, LG-2, J.V. Complex Opp. Yeshwant Club, Race Course Road, Race

Course Road, Indore

OIN/INV/2011/I189

dated 22/06/2011

Black current crush, Forest Fruit Crush, Green Apple Crush, Kiwi Crush, Muskmelon Crush,

Green Apple Syrup

75

9537 DTD 15.10.2005

Black Currant Syrup

257.40 Kg

71,300.00 71,300.00

76

33591121863 54 Bottles

12,420.00 12,420.00

77

27800300014C


710 Kg 326840

326,840.00

78

24571600064


1323 Kg

592,200.00 592,200.00

79

08720600732


11440 Kg

4,404,400.00 4,404,400.00

80 Black Currant crush

126 bottles

36,250.00 36,250.00

81

516 Bottles

148,587.00 148,587.00

82

27610646651

Pink guava Fruit Compound

100 Kg

90,000.00 90,000.00



OIN/INV/2011/I190

dated 22/06/2011


OIN/INV/2011/I191

dated 22/06/2011Forest Fruit Crush, Green Apple Syrup, Lemon

Green Tea Syrup, Strawberry Syrup

Valshad DCMPU Ltd, Vasudhara Dairy, Plot No. E - 23, MIDC, Tarapur IND Area, Boisar

(Maharastra)

OIN/INV/2011/I192

dated 24/06/2011

M/s Mother Dairy , A unit of Gujrat Co-operative, Plot no - 35, Near Indira Bridge

OIN/INV/2011/I193

dated 24/06/2011


Rajasthan

OIN/INV/2011/I194

dated 24/06/2011



CST No. 27720001492 C

OIN/INV/2011/I195

dated 28/06/2011



CST No. 07120245040

OIN/INV/2011/I196

dated 28/06/2011Kiwi Crush, banana Strawberry Crush, Black

Currant Crush

Pushpam Foods & Beverages Pvt Ltd, Gat No. 104/2A, Village - Barote Vasi(Nandur) -

Pune

OIN/INV/2011/I197

dated 29/06/2011

TOTAL 28059669.70 28,059,669.70 - 209,245.00

Note : Total must tally with figures in 2B(2)(b) of the return. 27,850,424.70

Place: GURGAON Date: Ful Signature of the authorised signatory

Name

DECLARATION: I ---------- (name in CAPITALS ) hereby declare that the contents of the above list and table are true and correct and nothing has been concealed therein.

Note:1. An authorised person alone shall sign each page of this list. A list signed by any person not authorised or an unsignd list shall be treateed as no list. 2. Where a list runs into more than one page, each page will show both page total

for Consumables


Name and style of businessD D M M Y

3 1 0 3 1TIN 0 6 0 7 1 8 2 8 3 1 8 Economic activity code

TIN Description of goods Quantity / Weight

@' 4% @' 0% @' 12.5%

1 2 3 4 5 6 7 8

0.00 0.00Note : Total of Columns 6-9 must tally with figure in 3A (3) (c ) of the return. TOTAL Col. 6-9

Gross


Name


@' 4% @' 0% @' 12.5%

1 2 3 4 5 6 7 8

FORM LP-3(See VAT-R1/ R6/ R7/ R8/ R9/ R11)

LIST OF PURCHASE OF GOODS IN THE COURSE OF INTERESTATE TRADE OR COMMERCE FOR THE QUARTER ENDED

Orana India Pvt. Ltd 7-HSIDC, Palam Gurgaon Road Gurgaon Haryana, PIN 122015

Sr.

No.

Name and address of the Dealer /Person form whom

goods purchased

Sale Invoice /Delivery

Note No./ Date

Break up of Value of goods leviable to tax at different rates in the State of Haryana

DECLARATION: I RAJESH DUDEJA (name in CAPITALS ) hereby declare that the contents of the above list and table are true and correct and nothing has been concealed therein.


Sr.

No.

Name and address of the Dealer /Person form whom

goods purchased

Sale Invoice /Delivery

Note No./ Date

Break up of Value of goods leviable to tax at different rates in the State of Haryana

0.00 0.00Note : Total of Columns 6-9 must tally with figure in 3A (3) (c ) of the return. TOTAL Col. 6-9

Gross


Name

DECLARATION: I RAJESH DUDEJA (name in CAPITALS ) hereby declare that the contents of the above list and table are true and correct and nothing has been concealed therein.


LIST OF SALE OF GOODS IN THE COURSE OF INTERESTATE TRADE AND COMMERCE FOR THE QUARTER ENDED

Y

1

Value of Goods

8 9

492

214

1,883

335

7,800

3,549

141

No. of Declaration in

Form 'C' issued, if any

Sold without

declaration in

form "C"

1,381

994

352

1,518

292

189

108

352

232

942

604

720

232

2,192

649

166

288

166

149

424

1,345

1,484

460

261

1,617

1,577

2,071

419

1,381

186

204

32,840

21,120

23,816

22,869

468

813

1,087

2,640

509

180

88,088

690

1,381

587

2,788

18,639

10,004

6,600

146

94

1,191

1,116

142

640

252

879

65,680

900

714

930

513

88,088

1,125

2,072

10,245

3,934

420

741

354

649

1,041

1,426

248

6,537

11,844

88,088

725

2,972

1,800

- 567,995

Ful Signature of the authorised signatory

Status

Y

1

@

9 10 B/F 28,059,670

TOTAL Col. 6-9 0.00Gross 28,059,670


@

9 10 B/F -


Break up of Value of goods leviable to tax at different rates in the No. of Declaration in




TOTAL Col. 6-9 0.00Gross -


For Raw Material



Name and style of businessD D M M

3 0 0 6 2 0TIN 0 6 0 7 1 8 2 8 3 1 8 Economic activity code


@ 2% @

1 2 3 4 5 6 7 8

1 27860246922C 1401200983/17.05.11

Pomegranate Concentrate 11440 Kg

2905760.00

2 27860246922C 1401201153/17.05.11


2905760.00

3 Mane India Pvt. Ltd. 28570126340 0350/23.06.11

Guava Flavour 25 Kg

15610.00

4

Alphanso Mango Pulp 149 Kg

9200.00

5 Freshtop Fruit Ltd, 10/13.05.11


964091.00

FORM LP-3(See VAT-R1/ R6/ R7/ R8/ R9/ R11)

Orana India Pvt. Ltd 7-HSIDC, Palam Gurgaon Road Gurgaon Haryana, PIN 122015

Sr.

No.

Name and address of the Dealer /Person form

whom goods purchased

Sale Invoice /Delivery Note

No./ Date

Break up of Value of goods leviable to tax at different rates in the

State of Haryana

Jain Irrigation Systems Ltd, Food Processing, Jalgaon Jain Food Park, Jain Velley, P.O. Box No. 20, Jalgaon, Maharastra - 425001


Foods And Inn Limited, National Highway No. 8, Vav Falia, Abrama, Valsad, Gujrat

FPP/11/2/2011-12/06.04.11

6 27860246922C 1401201153/23.06.11


2905760.00

7 N.A 123391/01.04.2011

Apple Flavour, Apple Flavour 50 Kg

200094.00

8 Prodalim B.V. N.A 1121043/01.04.2011

Orange Concentrate 10140 Kg

1420817.00

9 N.A 001148/06.04.2011

8622 Kg

878531.00

10 N.A 000001/13.04.2011

Peach Pieces In Light Syrup 50 Kg

19022.00

11 N.A 000003/13.04.2011

1188 Kg

125997.00

12 N.A 000007/14.04.2011

7053 Kg

655594.00

13 N.A 123437 / 19.04.2011

Aronia Concentrate 6000 kg

1124486.00

14 N.A 000022/27.04.2011

24278 Kg

1901736.00


Danish Fruit Production A/S Rynkebyvej 243, 5350 Rynkeby, Denmark

Orana Vietnam Co. Ltd. Lot 3-5, F1 Area, Tan Thoi Hiep I.Z, District 12, Ho Chi Minh City, Vietnam

Apple Green Tea Syrup,Apple Green Tea Syrup,

Lemon Green Tea Syrup,Strawberry Green Tea

Syrup, Strawberry Compound, Mango Syrup,Mango

SyrupOrana Vietnam Co. Ltd. Lot 3-5, F1 Area, Tan Thoi Hiep I.Z, District 12, Ho Chi Minh City, Vietnam


Mixedberry Fruit preperation, Strawberry Fruit

Preperation


Apple Green Tea Syrup,Peach Green Tea Syrup,Strawberry Green Tea Syrup, Green Apple Crush, Passion Puree Compound, Cranberry Compound, Passion of Guava Compound

Danish Fruit Production A/S Rynkebyvej 243, 5350 Rynkeby, Denmark


Red Cherry Filling, Dark Cherry Filling, Mango Syrup,

Strawberry Syrup, Lemon Green Tea Syrup, Lychee

Green Tea Syrup, Pineapple Fruit Preperation, Mango

Fruit Preperation,Tropical Mixed Fruit Preperation,

Peach Fruit Prepration, Mango Syrup, Strawberry

Syrup, Strawberry Syrup, Mango Syrup,

15 N.A 000030/03.05.2011

1175 Kg

137869.00

16 N.A 000035/10.05.2011

Strawberry Syrup 2500 Kg

492390.00

17 N.A 000040/17.05.2011

8631 Kg

812847.00

18 N.A 000052/25.05.2011

Strawberry Syrup, Mango Syrup 9675 Kg

772784.00

19 N.A 000063/15.06.2011

10848 Kg

975316.00

20 N.A 108178/ 01.03.2011

Red Grape Concentrate 21000 Kg

1695715.00

21 N.A 000073/22.06.2011

Pink Guava Fruit Compound 100 kg

34700.00



PreperationOrana Vietnam Co. Ltd. Lot 3-5, F1 Area, Tan Thoi Hiep I.Z, District 12, Ho Chi Minh City, Vietnam


Mango Syrup, Kiwi Crush,Peach Crush, Banana

Strawberry Crush, Black Currant crush, Strawberry

Filling, Black Currant Syrup, Green Apple Syrup,

Passion Fruit Syrup, Pink Guava fruit Compound, kiwi

Compound, Forest Fruit compound, Green Apple

Compound



Strawberry Syrup, Mango Syrup, Lychee Compound,

Strawberry Compound, Mixed Berry Compound

Orana Puchase A/c, Orana A/s, RYNKEBYVEJ 243, 5350 RYNKEBY, DENMARK


22 N.A 000075/28.06.2011

1152 Kg

132325.00

23 27270667984 DFIA/034/11-12

DFIL

300119.00

24 27290735679 MPC/C/JUL/11-12/17

DFIL

290168.00

25 27270667984 DFIA/074/11-12

DFIL

339715.00



Preperation

B D Internationala 203/A, Bank House, 3rd Floor, Room No. 2, Kalbadevi Road, Mumbai

M.P. Sons, 28 Kewal Industial Estate, S.B. Marg, Lower Panel, Mumbai - 400013

B D Internationala 203/A, Bank House, 3rd Floor, Room No. 2, Kalbadevi Road, Mumbai

TOTAL 11380223.00 10636183.00Note : Total of Columns 6-9 must tally with figure in 3A (3) (c ) of the return. TOTAL Col. 6-9

Place: GURGAON 3 1 0 3 2 0 1 1 Ful Signature of the authorised signatory

Name

DECLARATION: I ---------- (name in CAPITALS ) hereby declare that the contents of the above list and table are true and correct and nothing has been concealed therein.



Y Y

1 2

@ @

8 9 10



TOTAL Col. 6-9 22016406.00


Form LS-4(See VAT-R1 )

List of sale of goods in the course of export of the goods out of the territory of India for the quarter

ended 30.06.2011

Name and TIN of the registered dealer furnishing the list

Name and style of business ORANA INDIA PRIVATE LIMITED

TIN 06 07182831 Economic Activity Code

A - List of sale of goods under section 5 (1) of the Central Act– out of purchases u/s 5(3) of Central Act.

Date Description of goods

1 2 3 4 5 6 7 8 9

1

2

Total A 0

B - List of sale of goods under section 5 (1) of the Central Act– other than covered by Table –A.Date Description of goods

1 2 3 4 5 6 7 8 9

1 OIN EX 008 20.04.2011 1188 Kg 173124 Srilanka

2 OIN EX 009 12.05.2011 1175 Kg 170550 Srilanka

3 OIN EX 010 13.06.2011 90 Bottle 24060 Nepal

4 OIN EX 011 24.06.2011 210 Bottle 56400 Nepal

Sr. No.

Sale Invoice/ Delivery Note

No.

Name & address of the foreign buyer

No. & date of agreement/ order of

foreign buyer to whom goods sold

Quantity/ Weight

Value of the goods

Country of destination

Vessel or Airlines name, date of shipping/ Airfreight carrier number by which goods dispatched out of

India.

Sr. No.


No.

Name & address of the foreign buyer

No. & date of agreement/ order of

foreign buyer to whom goods sold

Quantity/ Weight

Value of the goods

Country of destination


India.

Fonterra Brands Lanka Pvt Ltd. 100, Delgoda Road,

11650 Blyagama, Colombo, Srilanka

10022184 Dt. 25.03.2011

Mixed Berry Fruit

Preperation, Strawberry

Fruit PreprationFonterra Brands Lanka Pvt

Ltd. 100, Delgoda Road, 11650 Blyagama, Colombo,

Srilanka

I0022839 Dt. 18.04.11

Mixed Berry Fruit

Preperation, Strawberry

Fruit PreprationTrishul, 48/57, Khadya

Bazaar Marg, Balkhu -14, Kathmandu, Nepal

Lemon Green Tea Syrup,Peach Green Tea Syrup, Strawberry Green Tea Syrup, Lychee Green Tea Syrup, Pink Guava Crush

Trishul, 48/57, Khadya Bazaar Marg, Balkhu -14,

Kathmandu, Nepal

Lemon Green Tea Syrup,Peach Green Tea Syrup, Strawberry Green Tea Syrup, Lychee Green Tea Syrup, Pink Guava Crush

.

Total B 424134

C - List of sale of goods under section 5 (3) of the Central Act.

Date TIN Quantity/ Weight

1 2 3 4 5 6 7 8 9 10

Total C 0

Note : Gross total of Total A, Total B and Total C must tally with figures in 2B(4)(b) of the return.

DECLARATION

I, (name in CAPITALS), hereby declare that the contents of the above list and table

are true and correct and nothing has been concealed therein.

Place :

Date : Full signature of the authorised signatory

Name

Status

Note :- 1. An authorised person alone shall sign each page of this list. A list signed by any person not authorised or an unsigned list shall be treated as no list.

2. Where a list runs into more than one page, each page will show both page totals and progressive totals

Sr. No.


No.

Name & address of the purchaser

Description of goods

Value of the goods

No. and date of purchase order

given by exporter

Number and date of agreement/ order received

by exporter from foreign buyer.

Name and address of the foreign buyer

Form LS-4(See VAT-R1 )

List of sale of goods in the course of export of the goods out of the territory of India for the quarter

ORANA INDIA PRIVATE LIMITED

9

9


India.


India.

10 11

(name in CAPITALS), hereby declare that the contents of the above list and table

are true and correct and nothing has been concealed therein.

An authorised person alone shall sign each page of this list. A list signed by any person not authorised or an unsigned list shall be treated as no list.

Name and address of the foreign buyer

No. & date of the certificate in form 'H' or form VAT-D2 issued by the

purchaser

Name & Address :M/S ORANA INDIA PVT. LTD.

TIN : Economic Activity Code :A. List of return of goods sold

Particulars of Debit-cum delivery Note(DDN) issued by the person to whom goods were sold and who returned the same Particulars of the original sale invoice(s) issued for the sale of goods

Name of the person issuing DDN TIN If held No Date Amount No

1

23

Total 0.00

B. List of escalation in the price of goods soldParticulars of suppliementary sale invoice issued to the purchaser for escalation in the price or goods sold previously Particulars of the original sale invoice(s) issued for the sale of goods

Name of the purchaser TIN If held No Date Amount No

1

I008 13.05.2011

293.45

2 PNP/HGST/7580 I009 19.05.2011 3308

3 PNP/HGST/7580

I010 19.05.2011

209

FORM LS-10(See VAT- R1)

List of goods returned and escalation or de-escalaltion in the price of goods sold for the quarter ended 31-03-2011

Sr.

no

Sr.

no

Amalgamated Bean Coffee Trading Co. Ltd C/O TCI Logistics, A - 25, Phase 1, Okhla Industrial Area, New Delhi

CST No. 07120245040 OIN/INV/2011-

12/,I134

Nestle India Ltd., Post Box No. - 01, Patti Kalyana Kiwana Road, Samalkha -

132101, Dist. Panipat, Haryana

OIN/INV/2010-11, 2011-

12 ,I078,I119,I128,I132,I133

Nestle India Ltd., Post Box No. - 01, Patti Kalyana Kiwana Road, Samalkha -

132101, Dist. Panipat, HaryanaOIN/INV/2011/I150

4

27110410052 I011 19.05.2011

1402.5

5 06641934947 I012 02.06.2011 15390

6 I013 02.06.2011 9131 OIN/INV/I026

7

07710224685

I014 13.06.2011 1071

8

27610646651 I015 13.06.2011

4794

9 I016 29.06.2011 3840

6

7

8Total 39438.95

C. List of de-escalation in the price of goods soldParticulars of Debit Note raised by the purchaser for de-escalation in the price or goods sold previously Particulars of the original sale invoice(s) issued for the sale of goods

Name of the person issuing DN TIN If held No Date Amount No

1

2

3

4

5

6

7

Total -

D. Summary of value of goods returned and descalation or de-escalation in the price of goods sold

(a) (b) ©(1) Local sales VAT & other

(I) @ 4 %(ii) @ 0 %

Schreiber Dynamix Dairies Ltd. , E-94, M.I.D.C, Bhigwan Road, Baramati - 413133, Pune - Maharashtra

OIN/INV/2010-11/I098

GFB Great Food Pvt. Ltd., Plot No. 36, Sector 3, Manesar - 122050

OIN/INV/2011/I031,I048

Horizon RHI, 32, Defence Colony, A Block Market, New Delhi

Barista Coffee Company Ltd.55 Community Center, Basant Lok Market,

Vasant Vihar, New Delhi - 110057OIN/INV/2010-11/I012

Pushpam Foods & Beverages Pvt Ltd, Gat No. 104/2A, Village - Barote Vasi(Nandur) - Pune

OIN/INV/2010-11/I165

Amalgamated Bean Coffee Trading Co. Ltd C/O TCI Logistics, A - 25, Phase 1, Okhla Industrial Area, New Delhi

CST No. 07120245040 OIN/INV/2010-

11/I186

Sr.

No

Name of sale and break up of turnover according to rate of tax

value of goods

returned

escalation in the price of goods sold

(2) Inter -state sales(I) @ %(ii) @ %(iii) @ %(iv) @ %

(3) Export Sales(4) Import Sales

Declaration:

Place : GURGAON For Climate Linkers

Date :(Authorised Signatory)

Break up of Sales

I J.B. KATARIA hereby declare that the contents of the above lists and tables are true and correct and nothing has been concealed therein.

M/S ORANA INDIA PVT. LTD.

Particulars of the original sale invoice(s) issued for the sale of goods

Date Amount Nature of sale

Total 0.00



05.05.2011 82461 Central Sale 2%

2,168,520

18.05.2011 317783 Local Sale 4 %

15.03.2011,14.04.2011,21.04.11,05.05.2011,05.05.2

011

Local Sale 5%, Local Sale 4 %

05.04.2011 13754 Central Sale 2%

25.01.2011,15.02.2011 234,653 Local Sale 4 %

25.02.2011 11095 Central Sale 2%

10.01.2011 1071 Central Sale 2%

25.05.2011 6994 Central Sale 2%

16.06.2011 37763 Central Sale 2%

Total 2874094



Total 0

De-escalation in the price of goods sold

(D) (e)=©-(b)-(d)

0.000.00

Net effect of goods

returned and

(de-)/escalation

hereby declare that the contents of the above lists and tables are true and correct and nothing has been concealed therein.

LIST OF SALE OF GOODS IN THE STATE FOR

THE QUARTER ENDEDD D M M Y Y

3 1 - 0 3 - 1 1Name and TIN of the VAT dealer furnishing the list

Name and style of business ORANA INDIA PVT LTD.

TIN 0 6 0 7 1 8 2 8 3 1 8 Economic activity codeA. List showing Sale of goods to registered dealers at full rate of tax

(A)Name with TIN of the registered dealer to whom goods sold (B) Turnover of Sale taxable at different rates

S. NO. Name TIN (I)@ 4 % (ii)@ 12.5% (iii)@ 5%

1 Nestle India Ltd PNP/HGST/7580 4,378,785.00

2 Nestle India Ltd PNP/HGST/7580 215775

3 Pepsico Holding India Pvt, Ltd. 00664300786 46000

4 Cocoberry Retail Pvt. Ltd. 81,900.00

40.00

Total 4,378,825.00 81,900.00 261,775.00 B. List showing Sale of goods to authorised dealers at lower rate of tax applicable under sec. 7(2)

(A)Name with TIN of the authorised dealer to whom goods sold (B) Turnover of Sale taxable at different rates

S. NO. Name TIN (I)@ 4 % (ii)@ 12.5 % (iii)@ %

1 -

Total 0.00 0.00 0.00

Note:- In list A and B.

2. Where a list runs into more than one page, each page will show both page totas and progressive totals.

C. Summary of taxable sales made in the State during the return period.(a) category of sale (b) Turnover of Sale taxable at different rates

S. NO. Name (I)@ 4 % (ii)@ 12.5 % (iii)@ 5 % (iv)@ %1 Sale to registered dealers at full rate of tax (List A) 4,378,825.00 261,775.00 2 Sale to authorised dealers at lower rate of tax (List B) 81900.003 Sale to unregistered dealers & consumers full rate of tax (List C) - 4 Total of row 1 to 3: 4,378,825.00 81900.00 261,775.00

Gross total of sub-colums (I) to (iv) 4722500.00

FORM LS-9(See VAT-R1)

1. There will be a single entry in respect of each registered/authrrised dealer to whomgoods have been sold during the return period. The date recorded on

a tax/ sale invoice will be taken as the date of sale for the purpose of aggregation sale made durin

Note : Gross total of sub-columns (I) to (v) must tally with figure in 2C (b) of the return.

DECLARATION : I ___J.B. KATARIA (name in CAPITALS ) hereby declare that the contents of the above list and tabel are true and correct and nothing has been concealed therein.

Full Signatures of the Authorised SignatoryPlace : GURGAON

Date :…………………………

Inv NoI128,I133,I132,I148,I149,I150,I159,I160,I179,I180,I182.I119.I127I120

29207638

Raw Material

LIST OF PURCHASE OF GOODS IN THE STATE FOR

THE QUARTER ENDEDD D M M Y Y

3 1 - 0 3 - 1 1Name and TIN of the VAT dealer furnishing the list

Name and style of business ORANA INDIA PVT. LTD.

TIN Economic activity codeA. List showing Purchase of goods from VAT dealers on tax invoice of full rate of taxS. NO. Name TIN (I)@ 4 % (ii)@ % (iii)@ %

1 0.00Total 0.00

GROSS TOTAL (I)+(ii)+(iii) 0.00

B. List of Purchase of goods from VAT Dealers on Tax Invoice at Lower Rates of Tax Application uncer section 7(2)

(a) Name with TIN of VAT dealer from whom goods purchased (b) Turnover charged to tax at different rates

S.NO. Name TIN (I)@ 4 % (ii)@ % (iii)@ %

Total 0.00

GROSS TOTAL (I)+(ii)+(iii) 0.00

C. List of Purchase of goods from Lump Sum Dealers(a) Name with TIN of Lump sum dealer from whom goods purchased

S.NO. Name TIN (I)@ % (ii)@ % (iii)@ %

Total

GROSS TOTAL (I)+(ii)+(iii)

D. List of Purchase of goods in the State without Payment of Tax(a) Name of person/ deealer from whom goods purchased

S.NO. Name TIN (I)@ % (ii)@ % (iii)@ %

Total

GROSS TOTAL (I)+(ii)+(iii)

DECLARATION

FUL SIGNATURE OF THE AUTHORISED SIGNATORYPlace Gurgaon Name Date Status

FORM LP- 7(See VAT-R1/R6/R11)

(b) Break up of turnover of purchase of goods according to rate of tax otherwise applicatio on goods

(b) Break up of turnover of purchase of goods according to rate of tax otherwise applicatio on goods

Note:-In Lists A, B, C and D,-1. There will be a single entry in respect of each dealer/person form whom good have been purchased during the return period. The date recorded on a tax/sale invoice by the selling dealer will be taken as the date of purchase for the purpose of aggregatin

2. Where a list runs in more than one page, each page will show both page totals and progressive totals. Sum of gross totals in lists A and B must tally with 3A (7)

(I) © in the return and in lists C and D with entry 3A (7) (ii) © in the return.

I _____________ (name in CAPITALS, herby declare that the contents of the above lists of purchase are true and correct and nothing has

been concealed therein.

NIL

VAT-R1 ORIGINAL/ DUPLICATE COPY OF RETURNFOR THE QUARTER ENDED ON

[See Rule 16(1) Table] D D M M Y Y1. Dealer's Identity 3 0 - 0 6 - 1 1Name & Style of Business ORANA INDIA PVT. LTD.

PALAM GURGAON ROAD

GURGAON(HARYANA)

TIN 06071828318 Economic Activity Code2. Gross turnover, taxable turnover of sales & comutation of tax (See Section (1)(u)3, 6 & 7 of the Act.)

(a) Discription (b) Value of goods

33,206,304.00

2B.DEDUCTION(1) Sale Outside the State (of Goods Purchased outside the State) - LS-1(2) Sale in the Cource of Inter-State Trade 28,059,670.00 LS-2(3) Sale in the Cource of Import into India - LS-3(4) Sale in the Cource of Export out of India 424,134.00 LS-4(5) sale of Exempted Goods in the State -

- LS-5(7) Value of goods sent for Sale to local Agents (VAT Dealers) - LS-6(8) Value of Goods Exported out of State (Consingment Transfers) - LS-7(9) Value of Goods Disposed of Otherwise than by Sale - LS-8(10) TOTAL OF (1) TO (9) 28,483,804.00

2C. TAXABLE TURNOVER OF SALES 2A(b)-2B(10)(b) 4,722,500.00 LS-9

2D (d) Rate of tax

1 4,378,785.00 - 4,378,785.00 4% 183,909

2 81,900.00 - 81,900.00 13.13% 10,749

3 261,775.00 261,775.00 5.25% 13,743 4 - 5 Total Tax Amount 208,402

3. Purchase, Import & Receipt of Goods & Computation of tax paid on Purchase made in the State( c) Amount

(1) Purchase ouside the State (for outside) LP-1 - (2) Purchase in the cource of export out of India LP-2 - (3) Purchase in the Cource of Inter State Trade LP-3 22,016,406.00 (4) Purchase in the cource of Import in to India LP-4 - (5) Import in to Stare LP-5 - (6) Received for sale from dealsers regd. Under VAT LP-6 - (7) (I) Purchase from VAT dealers on tax invoice

LP-7/8 -

(ii) Other Purchase in the State - (8) Total of rows (1) to (7) 22,016,406.00

(d) Rate of tax

1 - - - 4% - 2 - - - 3 - - 4 Add : Excess of VAT in last qtr 5,458.00 5 Total Tax Amount 5,458.00

4. Aggregate of tax levied on sale or purchase(1) Sale Tax 2D (5) 208,401.53 (2) Purcahse tax 11(4) (d) page3 - (3) TOTAL TAX (1)+(2) 208,401.53

5. Computation of input tax (see section 8 of the Act(1) Tax paid on purcahses made in the State 3B (5)(e) 5,458.00 (2) Lease tax paid, not part of input tax 10G(3) g - (3) Input tax (1) - (2) 5,458.00

6. Tax payable, refundable or adjustable(see section 20 of Act(1) Tax Payable 4(3) - 5(3) 202,943.53 (2) Tax adjueste under CST Act.(3) Refund Claimed(4) Excess Carried Forward 202,943.53

2A. Sale price received/ receivable in respect of goods and sold plus value of goods exported out of State or

desposed of otherwise than sale or sent to local agents(VAT dealses)

© List appended to the return

(6) Sale of Goods to UNICEF, UNTAB, WHO other Prescribe UN Bodies Foreign Missions

(a) Break up of 2c according to rate

tax

(b) Effect of reutrn of goods & (de-)/

escalation[LS-10]

( c) Net taxable turnover [(a)# (b)]

(e) Tax amount [( c)x(d)]

3A. (a) DescriptionAggregate of Price/ Value of goods

(b) List appeded to

return

(d) Stock as on 31st March last

to be given with return for 31/3

(a) Break up of 3A(7)(I) according

to rate tax

(b) Effect of reutrn of goods & (de-)/

escalation[Lp-8]

( c) Net purchaser [(a)# (b)]

(e) Tax amount [( c)x(d)]

Note:- if 6(1) is a negative value, the adsolute value there of will be carried forward for adjustment with future tax liability bur refund may be claimed in

case of. (I) Ecport of goods out of India. (ii) Difference in rate of tax or (iii) Inadvertent ex

Date : [ Signature of Authorised Person]

7. Details of tax deposited

Treasury Receipt (Tr)/ DD/PO/ RAO For office use

Type or Insuturment No Date Amount DCR No Date12345 Excess Paid Brought Forward From Last return6 Total of rows (1) to (7) -

8. Account of forms printed under the Government authority/required to be authenticated by theassesing authorityType of form

12 ST 38 (out)3 VAT-4 C5 E-16 E-II7 F8 H *

9. Staturory declaration and certificates received from the dealer furnished with the returnType of form Type of form

1 VAT-38(out) 1 C2 VAT- 2 D3 VAT- 3 E-14 VAT- 4 E-115 VAT- 5 F6 VAT- 6 H

Declaration:

Place:Date: (Signature)

For use in the Office of the Assessing Authority

(Affix Stamp of Name & Designation)

(Affix Stamp of Name & Designation)

ACKNOWLEDGEMENTThe undersigned acknowledges having received the original of this return on the date mentioned below:

(1) Date of receipt of return (2) Signature with Stamp of name & designation of receipt clerk)

sr.

No

Name or Treasury where tax deposeted or Bank on which DD Pay order drawn or office from where RAO issued etc.

sr.

No

Opening stock at the beginning of the ruturn peirod

Blank forms received or authenticated during the return period

Number of forms used during the

return period

Aggregate of amount of transction for

which forms furnished

Sr.

No.

No of Forms

furnished

Aggregate of amount transaction for which forms furnished

Sr.N

o

No of Forms

furnished

Aggregate of amount transaction for which forms furnished

1 I J.B. KATARIA (Name in CAPITALS, hereby solemnly affirm that I am authorised to furnish this return and all its contents including table 10 & 11 List, Statements, Declarations, Certificates & other documents appended to it or filed with it are

Status: Tick ( ) applicable [ Karta, Proprietor, Partner, Director, President, Secretary, Manager, Authorised Officer]

1. Date of data entry in VAT- Ragister/ Computer

2. Signature of the Offical Making the data entry:

3. Signature of the Assessing Authority with date:

Note: 1. Reference to sections or schedules in the Act in the return is indicative and not comprehensive. 2. A dealer who has not dealt goods in the circumstances specified in Schedule E or section 3(3) of the Act during the return period, does not have to

fill in the next page of the return.

Circumstances in which tax paid in respect of purchase of certain goods not to form part of input tax Purchase Value(a) (b)

A. Petroleum based fuels & natural gas purchased from VAT dealers on tax invoice and not resoldB. Capital goods purchased from VAT dealers on tax invoice.(1) For use mainly:- (i) In the manufacutre of exempted goods: (ii) In minning: (iii) In the Telecommunications Network: (iv) In the generation and distribution of electric energy or other form of power,(2) Which forrm part of gross block on the day cancellation of registration certificate takes effect

D. Rice purchased from VAT dealers on tax invoice when sold in the course of export out of India

E. All goods mentioned at A & B above purchased from VAT dealers on tax invoice when:

2. Exported out of State.3. Dispoded of otherwise than by sale;

5. Used in manufacture of packing of taxable goods which goods are:- (i) Exported out of state; or (ii) Disposed of otherwise than by sale,

F. Total A to E

G. Calculation of input tax at different rates (b) ( c) (d) (e) (f) (g) Total (b) to (f)

(1) Break-up of F (b) accourding to Tax Rates

(2) Rates of Tax.

(3) Input tax to be reversed (1) x (2)

Rate of Tax Purchase Tax(a) (b) ( c ) (d)

(4) Total [(1)(i)+(1)(ii)+ (2)(i)+ (2)(ii)+ (3)]

Date : [Signature of authorised person]

10. Computatio of tax paid in respect of goods purchased in the State from VAT dealer on Tax invoice which is not to from of input tax (See

Section 8(1) and Schedule E to the Act.

C. Paddy purchased from VAT dealers on tax invoice when such paddy or rice manufactured therefrom is sold in the course of export out of India

1. Used in the Telecommunications network, in mining or in the generation and distribution of electricity or other form of power.

4. Used in manufacture or packing of exempted goods (except when such goods are sold in the course export out of India

6. Left in stock, whether in the form purchased or in manufactured or processed form on the day cancellation of the registration certificate takes effect.

Notes : Where any goods purchase in the State are used or disposed of partly in the circumastances mentioned in colum (a) against entries A to E above and partly otherwise, the purchase value of such goods shall be computed pro-rate

11. Purchase tax [See section 3(3) of the Act]Circumstances in which purchase tax levied

Purchase value of goods taxable at different rates

(1) Taxable goods purchase in the State without payment of Tax when such

goods or the goods manufactured therefrom are either exported out of State

or used or disposed of (except when sold in the course of export out of

India ) in a manner that no tax or (2) Goods purchase in the State at lower rate of tax for specified purposes

but not made use of for true said purposes tax computed under provision to

section 7 (5)(3) Paddy purchased in the State without payment of Tax when such paddy

or the rice manufactured therefrom is exported out of India.

Note :- where any goods purcahsed in the State are used or disposed of partly in the circumstance mentioned in column (a) aginst entries at serial

number (1) and (2) above and partly otherwise, the purchase tax leiable on such goods shall computed pro-rat

4722500.00

FORM 1FORM OF RETURN UNDER RULE 7-A OF THE CENTRAL SALES TAX

(Haryana Rules 1957)

Returned of the Qtr endingod… 6/30/2011

Registration Make No…………

Name of the Dealer…………… M/s ORANA INDIA PRIVATE LIMITEDGP-28, 3rd Floor, Sector-18,GURGAON-122015(HARYANA)

Status : COMPANY Style Of Business:

1. Gross amounts received or receivable by the dealer during 33,206,304.00

period in respect of goods Deduct: (i) Sale of goods outside state - (ii) Sale of good in course of export out side India - (iii) Turnover of goods transferred outside the state as defined in Section-6A (1) -

2. Balance : Turnover on inter State sale deduct: 33,206,304.00 Deduct : Turnover on sale within the state 28,059,671.00

3. Balance :Turnover on inter state sales 5,146,633.00 Deduct : Cost of freight or installation when such cost is separately charged

4. Balance :Turnover of inter state sales. 5,146,633.00 Deduct : ( I ) Turnover on inter state sales of goods unconditionally exempted from tax under the Haryana General Sales Tax Act 1973 - (ii) Turover of sale sgoods returned by the purchase within a period of six months under section 8A (b) (i) of the Central Sales Tax Act 1957 - (iii) Turnover in respect of subsequent sales falling under clauses (a) & (b) of section -6 (2) of the Act -

5. Balance : Taxable turnover in respect of inter satate sales 5,146,633.00

6. Goodwise break up of the above (i) sold to registered dealers on prescribed declaration (Vide declaration attached) - (ii) sold otherwise

Total :(a) Taxable at 2% % Rs. 27,850,426.00 Tax Rs. 557,008.52 (b) Taxable at 5.25% % Rs. 209,245.00 Tax Rs. 10,985.36 (c) Taxable at % Rs. - Tax Rs. -

7. Total Tax Payable on Rs 28,059,671.00 amount to Rs. 567,993.88 8. a) Tax paid if any menas by Treasury Challan /Draft No Rs.

DD No. 570,012.00 b) Excess of VAT adjusted with CST payable Rs.9. Balance Due/ Excess paid if Any Rs. (2,018.12)

I Declare that the statement made and particulars furnished in and with return are true and complete.

Place Gurgaon Signature Date Status

VAT Summary

Payable Return

Sales Amount Vat Output Payment Detail

4% 4,378,785 175,151 VAT Paid Details:5.00% 261,775 13,089 4%

12.50% 81,900 10,238 Surchrge 5% on VAT - 9,924 5.00%

Less: Sales Return 18,907 - S.C 5%

Less: Surcharge Amount - - Less: Surcharge

Total 4,621,653 208,402 Total VAT & Surc Paid

Central Sale Amount CST

2% 27,850,426 557,009

4% - -

12.50% - -

5.00% 209,245 10,462 Less: Returned CST 2% 11,178 224

Less: Returned Without CST 9,131 - CST Paid Details:Less: Material Lost CST - - - Interest 1% Net Central Sales 28,079,980 567,247 Total VAT & Surc Paid

Export 424,134 NIL

Total Net Sales 33,125,767 NIL

Purchase Amount Vat Input Import 11,380,223 Central Purchase 10,636,183

Local 4% - -

Total Purchase 22,016,406

Return

Payment Detail

Amount 175,153

13,089

9,929 5

- -

198,171

570,012 - - 570,012

Documents

Vat Return (1st) Qtr)