FORM LA
(Return of Estimated Turnover)
(See Rule 3(2B)(a) & (b))

 

To

The Deputy / Commercial Tax Officer,
____________________________________
____________________________________
____________________________________

 

I_____________________________________________________________­____Son/Daughter/Wife of___________________________________________________________________on behalf of the Tobacconist known as_______________________________________________________________ furnish herewith the statement of estimated total and net turnover of Receipts during the year commencing from _______________________________________ (date/month/year) and ending on _________________________________(date/month/year) and give the following connected particulars.

 

(1) Name and Address of the Manager            :
of the firm

(2) Status of relationship of the person             :
       who signs this return
      (Manager/Partner/Proprietor etc.)

 

(3)   Name and address of the principal place                  :  
of Tobacconist with particulars of Registration  
Number.

A.P. Tax on Luxuries Registration  
Certificate No.                                           :  

  Address                                                    :

   

(4)  Name(s) of other places of Tobacconist       :  
and the address of every such place  
(if space provided for is not sufficient  
information shall be furnished in a separate  
sheet and enclosed to this return)

 

(5)  Date of commencement of supply Luxuries      :  
of tobacco products (date/month/year).

 

Statement of Estimated Total and Net Turnover of Receipts and Tax of the Tobacconist.

Tobacco Products		Estimated total turnover of Receipts	Estimated turnover of Receipts on which exemption is claimed	Estimated net turnover of Receipts	Rate of Tax	Estimated Tax	Total
Code	Description
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)
						TOTAL :

 

     DECLARATION :

          I,_______________________________________________________________________Son/Daughter/Wife
      of_________________________________________________________ declare that to the best of my knowledge and belief that the
      information furnished in the above statement is true and complete.

 

Place :

Date  :    
                                                                                  Signature_______________________Name___________________________________________________(in block letters)     

Status and relationship of the  tobacconist ____________________________________________________