Sending
Refund accrued on account of an Order passed by Court, Appellate Authority/Revising Authority
Refund on account of Court/Appellate/Revision Order- unregistered dealers (A-4B)
[See Rule .....]
Application by an Unregistered dealer for Refund Accrued on account of Order passed by court, appellate authority/revising authority under section ....... of the Haryana Value Added Tax Act 2003
1. Name of the Dealer *
2. Father's Name *
3. Email Id *
4. Address of Dealer *
5. State *
6. District *
7. Details of Refund Applied
Particulars VAT CST
(i) Refund Accrued on account of Order passed by
(ii) Order No. of Order of court, appellate authority/revising authority
(iii) Date of Order of court, appellate authority/revising authority
(iv) Date of Order passed by Assessing authority/Taxing authority
(v) Demand No. of Order passed by Assessing authority/Taxing authority
(vi) Assessment year
(vii) Amount of refund claimed as per order of court, appellate authority/revising authority
(viii) Details of amount deposited against which refund is claimed
VAT/CST Sr. No. GRN No. GRN Date Amount  
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8. Mode of Refund opted *
9. Bank account Details of the business firm *
Bank Name Branch Name & Address Type of Account Account Number IFSC Code
 
Verification
Certified that the above particulars are correct and true and no application for the refund being applied has been made earlier

The following documents will be submitted along with signed copy of the application form to the refund official of the concerned district within 3 working days from the date of submission of the application:
     (i) self-attested copy of Original Assessment order/ court order
     (ii) Bank Account Proof( Front page of the pass book)
     (iii) Identity proof(Aadhar card/ driving license/ Election card)

    
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