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THE KERALA VALUE ADDED TAX RULES 2005 FORM NO. 21H APPLICATION TO PAY ARREARS OF TAX IN INSTALMENTS See Rule 51 Tax payers Identification No Presumptive Tax payers Identification No Central Sales Tax No To The Assessing Authority with Office Address I. being an assessee under the Kerala Value Added Tax VAT Act 2003 hereby apply for permission to pay the tax assessed/due from me in instalments as per the following details Name and address of the assessee Amount of tax for which instaments are sought If the sums in column 2 are payable under an order of assessment the date of such order The period within which permission to pay the sum in column 2 is sought Reasons for the applicant s inability to pay the tax/other amount due within the specified date Other information if any DECLARATIONS I hereby declare that to the best of my knowledge and belief the information contained in the above application is true and correct. authority in regard to the sums mentioned in column 2 on the date of making this application* I hereby undertake to pay interest at the rate of. insert rate per annum along with each installment on the sums remaining unpaid from time to time. assessing authority for the recovery of the sums in relations to which the grant of installments is applied for. being an assessee under the Kerala Value Added Tax VAT Act 2003 hereby apply for permission to pay the tax assessed/due from me in instalments as per the following details Name and address of the assessee Amount of tax for which instaments are sought If the sums in column 2 are payable under an order of assessment the date of such order The period within which permission to pay the sum in column 2 is sought Reasons for the applicant s inability to pay the tax/other amount due within the specified date Other information if any DECLARATIONS I hereby declare that to the best of my knowledge and belief the information contained in the above application is true and correct. authority in regard to the sums mentioned in column 2 on the date of making this application* I hereby undertake to pay interest at the rate of. authority in regard to the sums mentioned in column 2 on the date of making this application* I hereby undertake to pay interest at the rate of. insert rate per annum along with each installment on the sums remaining unpaid from time to time. assessing authority for the recovery of the sums in relations to which the grant of installments is applied for. being an assessee under the Kerala Value Added Tax VAT Act 2003 hereby apply for permission to pay the tax assessed/due from me in instalments as per the following details Name and address of the assessee Amount of tax for which instaments are sought If the sums in column 2 are payable under an order of assessment the date of such order The period within which permission to pay the sum in column 2 is sought Reasons for the applicant s inability to pay the tax/other amount due within the specified date Other information if any DECLARATIONS I hereby declare that to the best of my knowledge and belief the information contained in the above application is true and correct. authority in regard to the sums mentioned in column 2 on the date of making this application* I hereby undertake to pay interest at the rate of. insert rate per annum along with each installment on the sums remaining unpaid from time to time. assessing authority for the recovery of the sums in relations to which the grant of installments is applied for.

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