(See Rule 17(5A) of A.P.G.S.T. Rules, 1957)
Statement of Particulars for the Purpose of Final Assessment
Name of the Dealer
A.P.G.S.T. R.C. No.
C.S.T. R.C. No.
Status of the dealer
Name(s) of the Proprietor,
Mg. Director, all Partners, etc.
Period of business during the
Addresses of branches and
godowns within the State
Addresses of branches outside the State
Address of factories within the State
Address of factories outside the State
Details of books of account maintained
(Specify whether computerized)
Enclose Trading and Profit & Loss Account
Enclose Manufacturing Account
In the case of Sec.5E transactions, enclose
copies of agreements applicable for the
year along with the list of lessees
In the case of Sec.5F/5G transactions
enclose copies of agreements and the list
of contracts executed during the year with
the amounts received from each contractee.
In the case of Tax Deduction at Source,
enclosed a statement showing the deductions
made, along with the certificates of deduction
issued by the contractees in original.
Whether the assessee deducted tax
under Sec.5H, if not reasons, therefor.
If the assessee deducted the tax for the
contracts done to him under Sec.5H,
enclose the list showing the deductions made
and me payments made to the Government.
Registration particulars under Sec.5B :
Particulars of L1 obtained for the year.
Number of Waybills obtained in the year
Number of forms obtained in the year
C declaration forms under the CST Act
F declaration forms under the CST Act
H declaration forms under the CST Act
G declaration forms under the APGST
Total amount of APGST collected in the year
Total amount of CST collected in the year
Details of industrial incentives i.e. Eligibility :
certificate numbers and dates in respect
of Tax deferment and Tax exemption.
(Furnish separate statement showing the
eligibility and availment, certificate-wise).
of inspection of the business
premises/ factory premises by the
Officers of C.T. Department and
Vigilance and Enforcement Wing.
statement showing the payment
of Compounding fee and penalty, if any.
30. Are all the purchases covered by invoices. :
Are bills issued for the sale of goods. :
Quantity and value of Diesel Oil purchased
at concessional rate for use in captive
Total number of units of power generated
through captive power generation.
34. Total number of declaration forms used :
in the year.
a) C forms under the CST Act :
b) El forms under the CST Act :
c) EII forms under the CST Act :
d) F forms under the CST Act :
e) G forms under the APGST Act :
f) H forms under the CST Act :
Payment particulars of Registration fee. :
Enclose A.R.I, II, III and IV Statements.
Signature of the Dealer
Name of the Ch. Acct. Designation