FORM B-5
(See Section 30-C)
NOTICE OF DEMAND OF FORFEITURE / PENALTY UNDER SECTION 30-C OF THE ANDHRA PRADESH GENERAL SALES TAX ACT, 1957.

To
Dealer                                                                                                                    Assessment No.   
                                                                                                                               Registration No.
           Take  notice that you have collected a sum of Rs. ............................................. / (in words ........................................................................................ by way of  tax, which is not payable / which is collected in contravention of the provision of Section 30-B of the APGST Act, which has been forfeited to the State Government under Section 30-C of the APGST Act.  This amount shall be paid within (thirty days) from the date of service of this notice by (cheque) (demand draft) in favour of the undersigned; or by remittance into the Government Treasury at 4(**) failing which the amount will be recovered as if it were an arrear of land revenue and you will also be liable to (interest) as provided in section 16 of the Andhra Pradesh General Sales Tax Act, 1957.

Seal:                                                                                                                            Signature

Place:                                                                                                                           Designation

(Ins. by G.O.Ms.No.244 Rev. dt. 17.5.1995)