Form A-XI Intimation under section 15 of the Bihar Value Added Tax Act, 2005 [See rule 11] To, The ........................................................................... .................................................................................................................... circle. I ................................................................................................... (full name), son of ...................................................................................................... (full name) hereby submit this information under sub-section (1)/(4)/(5)(a)* of the Value Added Tax, 2005 and through following particulars for that purpose - 1. Name and Style of Business ........................................................................................................................................................................................ ........................................................................................................................................................................................ 2. Taxpayer Identification No. ........................................................................................................................................................................................ 3. Gross turnover during the immediately preceeding year ..................................................................................................... (applicable to dealers opting to pay tax under sub-section (1) of Section 15 of the Act) 4. License No. under the Mines & Mineral (Development and Regulation) Act, 1957 ........................................................................................................................................................... (applicable to dealers exercising their option under sub-section (4) of Section 15 of the Act) 5. Proof of payment of tax in lieu of Tax Payable under the Act (applicable to dealers exercising their option under sub-section (4) of Section 15 of the Act) Amount ................................................................ Challan No. ........................................................................ Date .......................................... DECLARATION I do hereby declare that the particulars furnished in this application are correct and complete to the best of my knowledge and belief. I further declare that I am not a manufacturer of any goods other than Bricks and that I shall inform the Department as soon as I purchase/receive any goods other than those required by me in the manufacture of Bricks from outside Bihar. Place ................................................... Signature of the Applicant ......................................................................... Date ................................................... Status in relation to the dealer ......................................................................... Permanent Address ....................................................................................................................................................................................................................................... The application shall be signed by the proprietor of the business if an individual; by the Karta, if an undivided Hindu family; by an authorized partner in the case of a Firm; by a Managing Director, Managing Agent or Principal Executive Officer in the case of a Company or Corporation; by the Principal Executive Officer-in-Charge in the case of a Society, Club,Association, Department of Govt. or Local Authority. ACKNOWLEDGEMENT Received on ................................................... from .................................................................................................................... an application in Form A-XI for permission to pay tax under Section 15 of the Bihar Value Added Tax Act, 2005. Signature of Receiving Authority ............................................................ Designation ............................................................................................................................ * Strike out whichever is not applicable.
