APPLICATION FOR CLAIMING OF REFUND BY UN-REGISTERED DEALERS/ PERSONS [ See Sec 38(9) & Rule 35(13) ] FORM 510B Month Year Date 01.Tax Office Address: _____________________________________ _____________________________________ _____________________________________ 03. Name of the un-regd dealer ______________________________________________________ Address:______________________________________________________________________ _______________________________________________________________________ I/We have paid tax/ tax has been deducted at source from my/our amounts during the period -------------------- as following: Sl.No Name & address of the authority who collected the tax Name & address of the authority who Deducted the Tax at Source. Amount of tax collected/ paid Remarks 1. 2. 3. 4. 5. Therefore I / We request you that the tax paid above may be given as refund as per the provisions of the APVAT Act, 2005. Signature of the un-registered dealer/ Person.
