FORM  F1
Statement of Claim for reduction of Tax Paid on Purchases of Paddy
(See Rule 17D of A.P.G.S.T. Rules, 1957)

To

The Assessing Authority
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I/We request that under the provisions of rule 17D of the Andhra Pradesh General Sales Tax Rules, 1957, I/ We may be granted reduction of tax paid on paddy from out of the tax payable on Rice procured out of the said paddy and sold, as per details furnished below, in respect of the purchases of paddy, the particulars of which are given below:

(1)    (a) Name and address of the dealer from whom paddy is purchased.

 (b) His RC. No.

(2)    Bill No. and Date

(3)    (a) Quantity of paddy purchased and its value.

         (b) Quantity of rice obtained out of the quantity mentioned in item (a)

         (c) Quantity of rice sold out of the quantity mentioned in item (b).

         (d) Amount of tax paid on item (c) above with Challan No. / Receipt No. /

               Cheque / Draft and date of payment.     

(4)    Amount of tax paid on the paddy referred to in item 3(a)

(5)  (a) Month in which the selling dealer paid tax on the paddy referred to in item 3(a)

       (b) Particulars  of the assessing authority to whom tax was paid.     

       (c) Challan No. / Receipt No. / Cheque No. and date of payment.

Place :                                                                                  Signature


Date  :                                                                                    Status and Relationship to the dealer