Application No

Application No:320802/WR01/444/2008 THE KERALA VALUE ADDED TAX RULES, 2005 FORM NO. 10 Return [for VALUE ADDED TAX Dealer] (See Rule 22 (1)) To, AC (ASSESSMENT) SPECIAL CIRCLE TRISSUR

Year Sequence Return Period Nature of Return TIN CST NO

2008-2009 Monthly From 01-APR-08 To 30-APR-08

DEALER PARTICULARS

Original 32080204495

Name of the dealer LEO DISTRIBUTORS Address of the dealer LEO DISTRIBUTERS PHARMACEUTICAL (Principal Place) WHOLESALERS Details of Branch Phone No: Fax: Email: Website: Return Furnished for Principal Place PART A. TURNOVER DETAILS (VAT GOODS) A.(1,2,4)

(1) SALES /DISPOSALS (With output tax liability)

O

Co A. (3) Particulars of turnover of Dealer in medicine (paying tax under section 8) Turnover of medicines included under this head shall not be included under item A(i) Sl. Schedule Commodity No No

1 DRUGS III COSMETICS 2 MEDICATED V OR NOT TOTAL

Rate Output Output tax Total Exemption Taxable MRP of tax Due on Turnover Claimed Turnover Value Tax Collected MRP 4 36085754 12149736 23936018 36069662 1387295 1387294.69

12.5

528564 36614318

0

528564

0

12149736 24464582 36069662

66444

0

1453739 1387294.69

Sl. Schedule Commodity No No

1 DRUGS

III

Rate Output Output tax Total Exemption Taxable MRP of tax Due on Turnover Claimed Turnover Value Tax Collected MRP 4 36085754 12149736 23936018 36069662 1387295 1387294.69

Part J – Tax payment details * Instrument No/Date / Type

111967/09-MAY2008/CHEQUE TOTAL

Amount

Treasury/Bank

1468277 Dhanalakshmi Bank 1468277.00

Sub Treasury/Branch

THRISSUR