FORM A4

FORM A4
Return of Turnover of Agent
(See Rule 17B(a) of A.P.G.S.T. Rules, 1957 )

To

The Deputy Commercial Tax officer _______________________________________________

I,_____________________________________________________________Son/Daughter/Wife of_____________________________________________ on behalf of the dealer carrying on business known as _______________________________________________ furnish below the Statement showing the purchases/sales carried on by him on behalf of his principal(s) for the month of ________________________________________ (month/Year)

Statement showing The Total and Net Turnover of Business

Appendix	Total Turnover	Turnover on which Exemption is claimed	Net Turnover (2)-(3)	Total amount of tax due on the net turnover	Total amount of tax Collected	Tax provisionally paid	Balance Due	Particulars of payment of balance due
1	2	3	4	5	6	7	8	9
Appendix I Appendix II Appendix III Appendix IV								Amount: Cheque/Draft No.: Challan No.: Date : Treasury:
Grand Total :

DECLARATION

I_________________________________________________________Son/Daughter/Wife of ________________________________________________ declare that, to the best of my knowledge and belief, the information furnished in the above Statement is true and complete.

Place: Signature ___________________________

Date : Name (in block letters)____________________

Status and relationship to the dealer ______________

APPENDIX - I
Statement showing the purchases of goods (liable to tax at the point of purchase) Made on behalf of the principal liable to tax

Name and Address of the Principal with Reg. Cert. No.	Description of goods	Commodity Code number	Rate of tax	Name and Address of the Dealer with R.C. No. from whom goods are purchased	Invoice/sale patti/ thak Patti No. & Date	Quantity sold	Value of goods	Tax

1.	2.	3.	4.	5.	6.	7.	8.	9.

Total :

Note: 1. Show the turnover in respect of each commodity/goods in separate lines and then strike the total in the last line.

2. The total figures should be taken to the main return.

Signature

APPENDIX - II
Statement showing the purchases of goods (liable to tax at the point of purchase) made on behalf of the principal on which exemption is claimed.

Name and Address of the Principal with Reg. Cert. No.	Description of goods	Commodity Code number	Rate of tax	Name and Address of the Dealer with R.C. No. from whom goods are purchased	Invoice/sale patti/ thak Patti No. & Date	Quantity purchased	Value of goods	Tax

1.	2.	3.	4.	5.	6.	7.	8.	9.

Total :

Note: 1. Show the turnover in respect of each commodity / goods in separate lines and then strike the total in the last line.

2. The total figures should be taken to the main return.

Signature

APPENDIX - III
Statement showing the sale of goods (liable to tax at the point of sale) made on behalf of the principal liable to tax

Name and Address of the Principal with Reg. Cert. No.	Description of goods	Commodity Code number	Rate of tax	Name and Address of the Dealer with R.C. No. from whom goods are purchased	Invoice/sale patti/ thak Patti No. & Date	Quantity sold	Value of goods	Tax

1.	2.	3.	4.	5.	6.	7.	8.	9.

Total :

Note: 1. Show the turnover in respect of each commodity / goods in separate lines and then strike the total in the last line.

2. The total figures should be taken to the main return.

Signature

APPENDIX - IV
Statement showing the sales goods (liable to tax at the point of sale made on behalf of the principal on which exemption is claimed

Name and Address of the Principal with Reg. Cert. No.	Description of goods	Commodity Code number	Rate of Tax	Name and Address of the Dealer with R.C. No. from whom goods are purchased	Invoice/sale patti/ thak Patti No. & Date	Quantity sold	Value of goods	Tax

1.	2.	3.	4.	5.	6.	7.	8.	9.

Total :

Note: 1. Show the turnover in respect of each commodity / goods in separate lines and then strike the total in the last line.

2. The total figures should be taken to the main return.

Signature

APPENDIX - V
Statement showing the purchases of goods (liable to tax at the point sale) made on behalf of the principal

Name and Address of the Principal with Reg. Cert. No.	Description of goods	Commodity Code number	Rate of tax	Name and Address of the Dealer with R.C. No. from whom goods are purchased	Invoice/sale patti/ thak Patti No. & Date	Quantity purchased	Value of goods

1.	2.	3.	4.	5.	6.	7.	8.

Total :

APPENDIX - VI
Statement showing the sales of goods (liable to tax at the point of purchase) made on behalf of the principal

Name and Address of the Principal with Reg. Cert. No.	Description of goods	Commodity Code number	Rate of tax	Name and Address of the Dealer with R.C. No. from whom goods are purchased	Invoice/sale patti/ thak Patti No. & Date	Quantity sold	Value of goods

1.	2.	3.	4.	5.	6.	7.	8.

Total :

Signature

Additional Sheet for Appendix V

Name and Address of the Principal with Reg. Cert. No.	Description of goods	Commodity Code number	Rate of tax	Name and Address of the Dealer with R.C. No. from whom goods are purchased	Invoice/sale patti/ thak Patti No. & Date	Quantity purchased	Value of goods	Tax

1.	2.	3.	4.	5.	6.	7.	8.	9.

Total :

Additional Sheet for Appendix VI

Name and Address of the Principal with Reg. Cert. No.	Description of goods	Commodity Code number	Rate of Tax	Name and Address of the Dealer with R.C. No. from whom goods are purchased	Invoice/sale patti/ thak Patti No. & Date	Quantity sold	Value of goods	Tax

1.	2.	3.	4.	5.	6.	7.	8.	9.

Total :

Signature

Additional Sheet for Appendix I/III/IV

Name and Address of the Principal with Reg. Cert. No.	Description of goods	Commodity Code number	Rate of tax	Name and Address of the Dealer with R.C. No. from whom goods are purchased	Invoice/sale patti/ thak Patti No. & Date	Quantity sold	Value of goods	Tax

1.	2.	3.	4.	5.	6.	7.	8.	9.

Total :

Name and Address of the Principal with Reg. Cert. No.	Description of goods	Commodity Code number	Rate of Tax	Name and Address of the Dealer with R.C. No. from whom goods are purchased	Invoice/sale patti/ thak Patti No. & Date	Quantity sold	Value of goods	Tax

1.	2.	3.	4.	5.	6.	7.	8.	9.

Total :

Signature

Additional Sheet for Appendix II

Name and Address of the Principal with Reg. Cert. No.	Description of goods	Commodity Code number	Rate of tax	Name and Address of the Dealer with R.C. No. from whom goods are purchased	Invoice/sale patti/ thak Patti No. & Date	Quantity purchased	Value of goods

1.	2.	3.	4.	5.	6.	7.	8.

Total :

Name and Address of the Principal with Reg. Cert. No.	Description of goods	Commodity Code number	Rate of tax	Name and Address of the Dealer with R.C. No. from whom goods are purchased	Invoice/sale patti/ thak Patti No. & Date	Quantity purch-ased	Value of goods

1.	2.	3.	4.	5.	6.	7.	8.

Total :