TIN/GRN  *	TIN required
Name of the Dealer	Enter Name
Division	--Select-- ABIDS ADILABAD BEGUMPET CHARMINAR HYDERABAD RURAL KARIMNAGAR NALGONDA NIZAMABAD PUNJAGUTTA SAROOR NAGAR SECUNDERABAD TEST WARANGAL Select Division
Circle (Jurisdictional Assessing Authority)	Select Circle
Designation of Assessing Authority who passed order	Enter
Order Number	Enter order no
Order Date	Enter Date
Tax Period From - To  *	- Tax Period From Required Tax Period To Required
Select Act *	Select VAT CST TOT APGST Entertainment Tax Profession Tax Luxury Tax Entry Tax - Vehicles Entry Tax - Goods HRBT RDCESS Select Type of Tax
Balance tax payable as per order appealed against *	Amount Required
Disputed tax *	Amount Required
Admitted tax, if any *	Amount Required
Payment details of Admitted tax
Challan Number *	Enter Challan Number
Challan Date  *	Challan Date
Amount *	Amount Required
Payment details of 12.5% of the disputed tax
Challan Number *	Challan Number
Challan Date  *	Challan Date
Amount*	Amount Required
If not paid, pay here