FORM  A7  
(See Rule 17H 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 the business known as___________________________________________________________(Dealer name/Firm name) furnish herewith the Statement showing the amounts received due to price variation during the year commencing from _____________________________________________ and ending on ____________________________________ and give the following connected particulars.


1.   Registration Certificate Number

            APGST :  
 
           CST            :

2.   Address of the Principal place of business:

 

3.   Particulars of payment

(a)  Total Tax payable :

 

(b)  Tax paid             :

 

(i)  Cheque/DD Particulars

 

    Number :                                             Date :

 

                            Bank :                                               Branch :

 

(ii)  Cash (Receipt No if paid)     

 

    Receipt No.  :                                                      Date :

 

(iii)    Challan Particulars

 

           Number             :                                                Date :

 

   Name of the Treasury      :

 

     (c)  Balance Payable If any (a-b)      :


Statement of Commodity-wise tax and Turnover details  
No. of Commodities for which particulars are given  

Commodity

 

Total Turnover

Exempted

Turnover

Net Turnover

Total

Tax due

Amount

of tax

 collected

Tax

provisionally

paid

Balance

due

Particulars

of payment

of balance

due

 Description

Code

    (1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)



 

 

 

 

 

 

 

 

Amount Rs.



 

 

 

 

 

 

 

 

Cheque/

D.D.No.& Date



 

 

 

 

 

 

 

 

ChallanNo.

and 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 :                                                                                       Status and Relationship to the dealer____________________ 

                                                                                                    Name (in block letters) ____________________________