Application Form for opting Composition by an eligible drugs and medicine dealer in respect of scheme as notified by Government under sub-section (12) of section 16

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..... respect of scheme as notified by Government under sub-section (12) of section 16 Ward No. .. 1.TIN 2. Full Name of Applicant .....

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..... 4. Year for which composition scheme is sought* - .....

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..... (* Please complete Part B) 8. Details of Tax paid calculated as per (7) a .....

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..... (* Please attach original challan / proof of deposit) Name and signature of applicant / authorized signatory 9. Verification I/We __________________________________________ hereby solemnly affirm and declare that the information given hereinabove is true and correct to the best of my/our knowledge and belief an .....

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