FORM - D

(See Rule 4)

 

Return for the month / quarter ending

......................................................................

 

1.

Name and address of the dealer
 
 

.................................................................................................... ......................
................................................................................................ ..........................
..........................................................................................................................
2.
Registration certificate number under the Ordinance or the U. P. Trade Tax Act, 1948
 
3.
Name of commodities brought in the local area
 
   
Commodity
   
1
2
3
4.
(a) Aggregate value of goods (commodity wise)
Rs.............................. Rs.............................. Rs..............................
(b) Deduct value of goods on which tax has already been paid
Rs.............................. Rs.............................. Rs...............................
(c) Taxable value of goods Rs.............................. Rs.............................. Rs..............................
5. Tax payable Rs. ....................................................................
6. Tax realised Rs. ....................................................................
7. Tax paid (1) Amount Rs. ................................................
(2) Challan No. ...............................................
(3) Date ...........................................................

(4) Name of Bank ..........................................................................................

 

Declaration

 

       I .................................................(full name) being the ........................................(status) of the business known as ..................................................................................................... .................do hereby declare and verify that to the best of my knowledge and belief all statements and figures given in this return are true and complete and nothing has been wrongfully omitted or wrongly stated.

Signature ..........................................................
Status ...............................................................