Claim
for Refund
(See Rule 44AA of A.P.G.S.T. Rules, 1957)
1.
Name of the dealer.
2.
If refund is sought in pursuance of an order of assessment.
(i)
No. and date of order of assessment.
(ii)
Date of notice of final assessment and refund order.
(iii)
Date on which the notice of final assessment and refund order was served
on the dealer.
(iv)
Amount of refund order.
3.
If refund is sought in pursuance of an order passed in appeal or
revision.
(i)
No. and date of order of the appellate of revisional authority.
(ii)
Date of revised notice of final assessment and order of refund.
(iii)
Date on which the notice of final assessment and order of refund was
served on the dealer.
(iv)
Amount of refund due.
Signature of claimant.
Signature of the Authorised Representative if any.
VERIFICATION
Signature of the claimant.
Signature of the Authorised Representative, if any.
Note:This should be accompanied by the order of assessing, appellate or
revisional authority in pursuance of which the claim is preferred.