Original Duplicate Triplicate FORM S [See rule 9(2) ] No liability Certificate in respect of works contractor 1. Name and address of the dealer 2. TIN/Assessment year. 3.Status 4. Date of filing of application by the dealer for issuance of this certificate 5. Authority by whom works contract was assigned to the dealer with name, designation and address 6. Details of works contract: (a) No. and date of contract (b) Description of the contract (c) Duration of works contract (date of commencement and date fixed, for completion of works contract) (d) Address of works site (e) Value of contract Rs. I have examined the contract / purchases bills / returns filed in all details and to the best of my knowledge and belief I hereby certify that the dealer has no liability to pay tax in the execution of this contract / has paid the tax relating to this contract under section 5 of the Tamil Nadu Value Added Tax Act, 2006. Place: Signature of the Assessing Officer Name Date Designation Seal Note:Original and duplicate to be issued to the dealer applying for the certificate. Triplicate to be retained by the authority issuing the certificate. The dealer shall furnish the original to the person concerned and retain the duplicate.
