(a) Name and address of the dealer from whom paddy is purchased.
Bill No. and Date
(a) Quantity of paddy purchased and its value.
(b) Quantity of rice obtained out of the quantity mentioned in item (a)
(c) Quantity of rice sold out of the quantity mentioned in item (b).
(d) Amount of tax paid on item (c) above with Challan No. / Receipt No. /
Cheque / Draft and date of payment.
Amount of tax paid on the paddy referred to in item 3(a)
(5) (a) Month in which the selling dealer paid tax on the paddy
referred to in item 3(a)
(b) Particulars of the
assessing authority to whom tax was paid.
Challan No. / Receipt No. / Cheque No. and date of payment.