Commercial Taxes Department

Type of Dealer*		Registered Unregistered
1. TIN

2. Details of the Dealer who applies for Form S
i. Name of the Dealer*
ii. Address of the Dealer
a) Door / Plot No Old		b) Door / Plot No New*
c) Building Name		d) Shop / Office Number
e) Street / Road*		f) Village / Town / City*
g) District*		h) PIN*
i) Circle *
3. Section under which Tax is being paid and return filed*
4. Whether returns filed up to the month*		Yes No


5. Details of Contractee who awarded the contract
i. Do you have TDN?*		Yes No
ii. TDN of the Contractee
iii. Name of the Contractee*
iv. Address of the contractee
a) Door / Plot No Old		b) Door / Plot No New*
c) Building Name		d) Shop / Office Number
e) Street / Road*		f) Village / Town / City*
g) District*		h) PIN*
v. Mobile Number*
vi. E-Mail Id*

6. Details of Works Contract
Previous Form-S obtained for contract ?*		Yes No
i. Contract Agreement No.*
ii. Date of Contract*		iii. Description of the Contract*
vi. Date of Commencement of Works Contract*		v. Date Fixed for Completion of Works Contract*
iv. Duration of Works Contract*		vii. Value of contract*
7. Turnover reported till date in the monthly returns for the above contract. (If so furnish the details in the separate annexure)
8. Whether tax dues paid for the above turnover reported (If not, specify reasons)*		Yes No
If No, Specify Reasons

Sub Contract Details

9. If Contract has been sub contracted*

Yes No

i. TIN

ii. Name of Sub-Contractor*

iii. Nature of Contract*

iv. Value of Contract*

v. Value of Contract executed till date*

vi. Period of Contract(In days)*

vii. Work Order No.*

viii. Date of Work Order No.*

Sr No.	Delete	Modify	TIN	Name of Sub-Contractor	Nature of Contract	Value of Contract	Value of Contract executed till date	Period of Contract	Work Order No.	Date of Work Order No.

Works Completion Details

10. Value of contract completed up to the date of making this application for Form S*
11. Balance Value of contract to be executed

12. Previous Form-S obtained for this contract (if any).*		Yes No
Details of Previous Form S
Previous Form S No.
Previous Form S Date
Previous Form S Value

Statement of Material Purchase and Expenses incurred in respect of execution of the above Contract

		%
A	Purchases for the period
	Purchase of Material month wise to be reported - (if first time then starting from dt of contract to dt of application and if second time then from last application till date of application)
B	Local/CST/Import	5%
		14.50%
	U/S 12- (URD) for local purchases alone	5%
		14.50%
C	Add: Transportation cost incurred
D	Add: Loading & Unloading cost incurred
E	Add: Any other direct Expenses
F	Cost of Material involved in the execution of the Contract
G	Labour and Wages
H	Indirect Expenses
I	Margin / Profit
	Total*