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FORM 12 |
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[See Rule 19] |
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Return of tax payable by a dealer |
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Initials of receving clerk |
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Date of Receipt of Return |
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Consolidated/Branch |
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Return of tax payable for the period from |
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Name of the dealer |
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Address |
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Registration Certificate No. |
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Income Tax |
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G.I.R. No. |
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Permanent Account No. |
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Name and Address of the branches in Chhattisgarh, If any:- |
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(1) |
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(2) |
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(3) |
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(4) |
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1 |
(a) |
Gross Turnover |
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(b) |
Less |
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(i) |
Cost of freight, delivery or cost of installation separately
charged to the customers |
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(ii) |
Cash discount allowed. |
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(iii) |
Sales price of goods returned within six months of sale |
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Total |
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Net G.T.O. |
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2 |
Less: Deductions.- |
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(a) |
Under clause (w) of Section 2,- |
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(i) |
Under sub-clause (i), sale price of goods declared tax-free
under Section 15 or wholly exempted under section 17 |
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(ii) |
under sub-clause (ii), sale price of tax paid goods |
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(iii) |
under sub-clause (iii) slae price of goods sold against a
declaration in form 26 |
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(iv) |
under sub-clause (iv), sale price of goods against a
decleration in form 27 |
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(v) |
under sub-clause (v) amount collected by way of tax and
included in the turnover\ |
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(vi) |
under sub-clause (vi), deductions under Rule 35 in respect of
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(i) |
[
.] canteen stores under clause 91) |
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(ii) |
sale price of medicines, medical, surgical, vaternary
instruments and equipments under clause (2) |
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(iii) |
sale price of goods used by a contractor / sub-contractor in
the course of execution of a works contract on which tax has
been paid by the sub-contractor/contractor, under clause
(3)/(4) |
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(iv) |
sale price of goods sold in xontravention of the provisions of
clause (a) or clause (b) of sub-section (2) of Section 9 [
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(vii) |
(a) |
sale price of a goods sold in accordance with the provision of
proviso to sub-section (3) of Section 9. |
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(b) |
in respect of sale price of taxable goods sold through an
adatiya on whixh tax [is] payable or paid by adatiya. |
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(c) |
under section 79 in respect of sale price of goods sold, |
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(i) |
outside the state |
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(ii) |
in the course of inter-state trade or commerce |
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(iii) |
in the course of import into or export out of theterritory of
India. |
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(iv) |
in the course of export out of the territory of India within
the meaning of sub-section (3) of Section 5 of the central
Sales tax Act, 1956 (Last sale preceding export) |
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(d) |
any other deduction (give particulars) |
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3 |
Total |
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4 |
Net taxable turnover |
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5 |
Ratewise breakup of taxable turnover |
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(a) |
at full rate |
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(b) |
at concessional rate, - |
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(i) |
under Section 9(2) |
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(ii) |
under Section 17 |
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6 |
Tax payable on the taxable turnover:- |
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(a) |
at the full rate |
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(b) |
at concessional rate,- |
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(i) |
under Section 9(2) |
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(ii) |
under Section 17 |
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7 |
[Total} tax payable on the taxable turnover |
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8 |
Aggregate to taxable purchase price |
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9 |
Ratewise breakup of aggregate of taxable purchase price,
taxable,- |
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(a) |
at full rate |
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(i) |
at the rate under section 10(1) |
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(ii) |
at the rate under section 21 |
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(b) |
at concessional rate,- |
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(i) |
under section 10(2) |
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(ii) |
under section 17 |
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10 |
Tax payable on the taxable purchase price,- |
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(a) |
at full rate,- |
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(i) |
at the rate under section 10(1) |
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(ii) |
at the rate under section 21 |
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(b) |
at concessional rate,- |
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(i) |
under section 10(2) |
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(ii) |
under section 17 |
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11 |
Total purchase tax payable |
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11A |
(a) |
Total turnover of resale of goods as per the provisions of
Section 9-B |
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(b) |
sale price of declared goods |
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(c) |
sale price of goods at the hands of the registered dealers
from whom they have been purchased. |
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(d) |
any other deductions (give particulars) |
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(e) |
amount collected by way of tax and included in turnover or
arrived at in accordance with the provisions of sub-clause (v)
of clause (w) od section 2 |
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(f) |
taxable turnover [a-(b+c+d+e)] |
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(g) |
ratewise breakup of taxable turnover (@4%) |
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(h) |
Tax payable under section 9-B |
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12 |
Total tax payable during the period under return [(7+11+11A)] |
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13 |
(i)
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Purchase price of tax paid goods in respect of which set off
claimed under sub-section (1) of section 13 |
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(a) |
under clause (a) |
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(b) |
under clause (b),- |
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(i) |
under sub-clause (i) |
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(ii) |
under sub-clause (ii) |
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Total |
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(ii) |
Amount of ste off claimed under sub-section (a) of Section
13,- |
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(a) |
under sub clause (a) |
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(b) |
under sub-clause (b),- |
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(i) |
under sub-clause (i) |
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(ii) |
under sub-clasue (ii) |
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Total |
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14 |
Tax payable after adjuestment of set off (12-13) |
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15 |
Amount of Tax credited by refund adjustment order, in any |
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16 |
Balance of tax payable (14-15) |
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17 |
Tax Paid with chalan No. and dates |
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18
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Balance of set off, if any, to be carried over in the return
for the next quarter of the year (not being a return for the
first quarter of the subsequent year) |
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Place |
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Date |
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Signature of the Dealer |
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The particulars given above are true to the best of my
knowledge and belief. |
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Place |
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Date |
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Signature of the Dealer |
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ACKNOWLEDGEMENT |
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Received a return in Form 12 relating to the period from
to
from Shri
. holding Registration
Certificate no. ------------------------ with the following
documents., - |
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1. |
Challan No.
Dated
for Rs.
.. |
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Challan No.
Dated
for Rs.
.. |
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Challan No.
Dated
for Rs.
.. |
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Challan No.
Dated
for Rs.
.. |
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2. |
Statement in Form 19 |
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3 |
Any other documents |
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Total No. of Documents - |
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Place |
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Seal of Office / Signature and full name of
the official receving the return. |
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Date |
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* Strike out whichever is not applicable. |
