FORM 22
[See rule 24 (1) and (4)]
Application for grant / renewal of exemption certificate
To,
The Commercial Tax officer
……………….
Circle.
I
……………………….
proprietor/ partner/ director/ manager of the business known as
……………………
being a dealer, holding permanent registration certificate no
…………………
under the Chhattisgarh Commercial Tax Act, 1994, whose only/
*principal place of business for which the exemption certificate is
required is within the jurisdiction of the Commercial Tax ……..
officer and is situated
……………………………..
Town /village………………..
District
………………..
Tehsil
………………….
Municipal ward no …………………
(for municipal area only) do hereby Apply.
*for grant of an exemption certificate in form 23 under rule 24 (1)
of the Chhattisgarh Vanijyik Kar Niyam, 1995.
*for renewal of the exemption certificate in form 23 dated
……………….
(sent herewith) granted to me, the validity of which expires on
……………..
2. I hereby declare that i am neither an importer nor a
manufacturer.
3. I hereby declare that no sales or purchases of any goods
are Likely to be made by me which will be liable to tax under the
Chhattisgarh Commercial Tax Act, 1994.
4. I hereby declare that during the period from
……………….
to
……………..
I made no sales or purchases, which were subject to Tax under the
said act.
5. I seek grant/renewal of the exemption certificate for
further Reasons stated below,(here state further reasons if any).
6. If during the validity of the exemption certificate in
form 23 which may be granted to me/*renewed I make any sale or
purchase of goods which is subject to tax. I undertake to intimate
the fact Within the fifteen days of the date of my incurring
liability to pay Tax on such sale or purchase to the commercial tax
officer and shall within one month from the expiry of the quarter in
which I May incur such liability, furnish a return in form 12 and
also pay in To government treasury within the same period the tax
payable According to such return and shall submit to the commercial
tax Officer a treasury receipted Chalan as evidence of such payment.
Place
…………………..
Date
…………………..
Signature of the dealer
Note:- In case the application in for renewal, the application
should be accompanied by exemption certificate in form 23.
Acknowledgement
Received an application from
…………………………..
(name of the dealer) for*grant/ *renewal of exemption certificate
under rule 24 of the Chhattisgarh Vanijyik Kar Niyam, 1995.
Place
…………………
Date
…………………
Signature
Seal of the office |