BOND OF INDEMNITY
I, Shri .... son of Shri residing at .. P.S .. P.O .. . District Proprietor/ Partner/ Manager/ Principal Officer of the business known as at . and possessing a certificate of registration bearing No in the State of Odisha issued under the Odisha Sales Tax Act, 1947, do hereby declare that the declaration form bearing No . issued to me by the Sales Tax Officer Circle, on is lost/destroyed/stolen (1) from my custody before being filled in or signed by me, (2) from my custody after being filled in and signed by me but before despatch to the selling dealer, namely . (3) in transit after being duly filled in and signed by me and despatched to the selling dealer, namely
And, I, the aforesaid Shri do hereby undertake to hold harmless and to indemnify the Government against any loss arising out of the aforesaid loss of declaration form.
And I bind myself, my heirs, executors, administrators and assignees and each one of the other persons having any share, title or interest in the aforesaid business and his heirs, executors, administrators and assignees jointly & severally for holding harmless and indemnify the Government for any such loss as aforesaid.
(To be printed in quadruplicate)
2(See rules 7, 37, 37-A and 37-AA)
Challan No .. 040 Sales Tax (b) Receipts under the State Sales Tax Act (A)- Tax Collection (B)-Surcharge (Additional Sales Tax).
3 [Tax and surcharge] Treasury
Challan of Composition money Paid at the Branch of the State Bank of IndiaFees / Interest
For the month / quarter / year ending .
Date Signature of the Dealer or Depositor
(For use in the Treasury)
Treasurer / Accountant Treasury Officer /
Agent or Manager
Application for grant of certificate of no deduction / deduction of tax at source from Works Contractor under Sub-section (5) (a) of Section 13-AA of the Odisha Sales Tax Act, 1947 (To be submitted in duplicate).
Signature of applicant.
Application for refund of tax under section 14 of the Odisha Sales Tax Act, 1947
(See Rule 39)
I . Proprietor/ partner/ manager/ principal officer (authorised departmental) of the business known as .. bearing Registration Certificate number .. whose only / chief place of business in the district of is situated at . P.O .. pray for refund of Rs. being the amount of excess [tax/ surcharge/ penalty/ security/ interest] paid by me. The refund may be paid in cash / by Refund Adjustment Order payable at the .. Treasury / Sub-treasury.
Final order on appeal, revision ( ) or reference.
(ii) Challan Number ..
(iii) Date of payment
(Quote No. and date of order) ..
I . the applicant named above, do hereby declare that what is stated herein is true to the best of my knowledge and belief, (and also further declare that the amount of refund claimed above has been paid by me that the amount or any part thereof has not been realised by me by way of tax or otherwise from any person or persons.
Statement of Claim for Refund of Tax paid on sales or purchases of Declared Goods
(See Rule 42-A)
The Assistant Sales Tax Officer,
Sales Tax Officer,
I . Proprietor/ partner/ manager/ principal officer (authorised departmental) of the business known as .. bearing Registration Certificate number .. whose only / chief place of business in the district of is situated at . P.O .. pray for refund under the provisions of rule 42-A of the Odisha Sales Tax Rules, 1947 in respect of goods, the particulars of which are given below. The amount may be made payable at the Treasury / Sub-treasury at .
I . the applicant named above do hereby declare that what is stated above is true to the best of my knowledge and belief and also further declare that the amount of refund claimed above has been paid to Government and was not claimed earlier.
(See Rule 91)
SALES TAX TRIBUNAL, Odisha
Statement showing the particulars of appeals/applications for reference disposed of by the
Tribunal during the period from ..
(See Rule 94-D)
Name of Transport Co.
Please receive the under mentioned consignments and forward by Road Transport to as consigned below :
I do hereby certify that I have satisfied myself that the description marks and weight or quantity of goods consigned by me have been correctly entered in this forwarding note.
Signature of the Dealer
Or his authorised agent
(To be filled in by the Transporter) Date . Address
(Despatch Register to be maintained by the Transporter)
(See Rule 94-D)
(Delivery Register to be maintained by the Transporter)
(See Rule 94-D)