APPLICATION FOR REFUND OF TAX TO AGENCIES OF U.N.O., ICRISAT ETC., FORM 510A [ See Rule 35(12) ] Date Month Year 01.Tax Office Address: _____________________________________ _____________________________________ _____________________________________ 02.Name : Address: We have purchased the following goods in Andhra Pradesh during the period ________ Name of the Invoice Value VAT / Rate of TIN / Com- Quantity Dealer from Remarks No. & Address of the TOT Tax S.No. GRN modity whom Date Goods Paid Charged purchased Total tax claimed as Refund Therefore, we request you that the tax paid on the above purchases may be given as refund as per the provisions of the AP VAT Act 2005. Signature of Authorised Officer, Name & Status. Officer Stamp 159
