GOVERNMENT OF JHARKHAND COMMERCIAL TAXES DEPARTMENT [See Rule 16(1)] Application for Grant of Instalment for Payment of Tax Instructions: 1. Please ensure that the form is complete 2. Affix court fee stamp as prescribed. 3. Enclose copy of the order and notice of demand 4. This Form should be verified and signed by: a. Proprietor, in case of Proprietorship concern b. Managing Partner, in case of Partnership firm and where there is no Managing Partner, by all the partners if there is no registered partnership deed and in case of a registered partnership deed by any one of them. c. Managing Director or authorized signatory, in case of a Company d. Karta, in case of Hindu Undivided Family e. Authorised Signatory, in all other cases f. Or by the declared Business Manager 1. Name of the Dealer ___________________________________ 2. Registration No. (TIN) ___________________________________ 3. Address Building Name/Number ___________________________ Area/Road ___________________________ Locality/Market ___________________________ Pin Code ___________________________ Telephone Number(s) ___________________________ Fax Number(s) ___________________________ 4. Date of service of order ___ ___ / ___ ___ / ___ ___ ___ ___ DD / MM / YYYY 5. Section, under which order passed _______________________________ 6. Tax period to which the order relates _______________________________ 7. Demand created in the order _______________________________ 8. Demand deposited, if any (Enclose proof of payment) _______________________________ 9. Bifurcation of Tax _______________________________ demand due Interest _______________________________ Penalty _______________________________ Other sums _______________________________ TOTAL _______________________________ 10. Time period and intervals sought for payment of demand due _______________________________ 11. Grounds for allowing to pay demand in instalments Enclose additional sheet(s) in case you are not able to provide all details in this space Enclose all documents/ evidence that you want considered regarding your application Verification I verify that the information given above and is its enclosures (if any) is true and correct to the best of my knowledge and belief and nothing has been concealed Signature Name Designation Date Place
