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FORM
59-A-2
[
See rule 74-aa(2)(b)]
Application
for obtaining books of declaration Forms
To,
The
Commercial tax officer
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Sir,
* I/ we
am/are carrying on business under the name
and style of
..situated
at
..
(City/ town/ village)
tehsil
.District
and holding registration certificate No
.
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1.
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*I/We
request that
..books
of declaration form 59-A containing 50 Forms in
quadruplicate be supplied to *me/us, the fee for which *I/We
have paid into the treasury and in support of which *I/we
enclose a treasury receipted Challan in Form 39 bearing No
..Date
..
Rs.
..
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2.
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*I/We
declare that *my/our registration certificate mentioned
above is in force and has not been cancelled by this date.
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3.
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*I/We
further declare that *I/We am / are not in arrears of any
tax and/ or penalty for any period under the Act.
OR
*I/We
are in arrears of tax/ or penalty under the Act, the
particulars of which are given below:
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Period
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Amount
of tax/ penalty
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1.
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2.
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3.
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4.
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*Signature
of the Proprietor/ Manager/ Secretary of the company/
partner of the firm.
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Received
books
containing form No.
From
to
..
..
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Signature
of the dealer or his authorised representative
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*Strike
out whichever is not required.
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