FORM 12 (See rule 17 and 20) Order of assessment of tax under section 14/ of the Goa Tax on Luxuries Act, 1988. Name and address of the Hotelier ... ... ... Assessed u/s. ... Notice in Form ..... served on ...... Luxury Tax R. C. No. ......... Period of Assessment from ..... to ........ Books of Account produced ........... Accounting Method .......... As in the As Hotelier's determined return u/s. 14/16 (in Rs.) (in Rs.) Part I -Turnover of receipts liable to tax - 1. Total turnover of receipts of the hotelier during the period: Deduct - (A)Turnover of receipts, where the charges for luxury provided in the hotel is less than one hundred rupees. (B)Turnover of receipt on which tax is not payable on account (other than (A) above) of 2. Net turnover of receipts liable to tax; Signature..... Designation ... Part II - Calculation of tax payable. 3. Calculation of tax - As in the Hotelier's As determined u/s. return 14/16 Serial No. Categories of receipts which are the constituents of turnoverat Item No.2. Tax rate Turnover of receipts Deduction u/r. 15 Balance turnover ofreceipts Tax Payable Turnover of receipts Deduction u/r. 15 Balance turnover ofreceipts Tax payable 1 2 3 4 5 Where the charge for luxury is - 6 7 8 9 10 11 (i) One hundred rupees or more but does not exceed five hundred rupees. 5% (ii) Exceed five hundred rupees. Total 10% Part III - Amount payable/ refundable. 4. Total tax payable as per Part-II Deduct- (A) Amount credited under refund Adjustment Order No.... dated .... Rs.... (B) Advance payment of tax, if any (C) Amount paid with returns. Details of payment made at (B) an d(C) above. (D) Total amount deducted on account of (A), (B) and (C) above. 5. Balance of tax due/ refund if any Add - (A) Interest u/s. (B) Penalty u/s. (C) Amount forfeited being the sum collected in contravention of section 24. (D) Total amount added on account of (A), (B) and (C). 6. Final amount due/ refund, if any Part IV - Assessment order- As in the As determined Hotelier's u/s. 14/16 return Seal Signature .... Place..... Dated .... Designation
