section Schedule - Form (Part A Continued)
Application for Settlement of Arrears
The Goa (Recovery of Arrears of Tax through Settlement) Act, 2009(11) Net amount of arrears applied for settlement Tax Rs. Interest Rs. Penalty Rs. Total Rs.
VERIFICATION I/We .................................................. solemnly declare that to the best of my/our knowledge and belief,— (a) the particulars and information given in this application are correct and complete; (b) the amount of arrears of tax, interest and penalty shown hereinabove are truly stated and relate to the relevant period as mentioned in this application; and (c) I/ the applicant am/is not otherwise ineligible for making this application in terms of the provisions of said Act.
(Signature) (Name of the signatory in full) (Status in relation to the applicant) Place: Date:
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