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The Goa (Recovery of Arrears of Tax through Settlement) Act, 2009

Goa · state statute
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The Goa (Recovery of Arrears of Tax through Settlement) Act, 2009 
1. The Goa (Recovery of Arrears of Tax through Settlement) Act, 2009 (Goa 
Act 17 of 2009) [20 -8-2009] published in the Official Gazette, Series I No. 21 
(Extraordinary) dated 25th August, 2009 and came into force at once. 
2. The Goa (Recovery of Arrears of Tax through Settlement)  (Amendment)                   
Act, 2016 (Goa Act 1 5 of 2016) [29-8-2016] published in the Official Gazette, 
Series I No. 23 (Extraordinary) dated 9-9-2016 and came into force at once. 
 
 
Section Title Amendment Act 
15 of 2016 
 Long Title Amended  
1 Short title, extent and commencement  
2 Definitions Amended  
3 Designated authority  
4 Eligibility for settlement Substituted  
5 Application by the applicant Amended 
6 Determination of amount payable for settlement of arrears Amended 
7 Rate applicable in determining the amount payable Substituted  
8 Settlement of arrears and issue of certificate of settlement Amended  
9 Bar on re-opening of settled cases  
10 Withdrawal of review application, appeal and revision  
11 Reviewing, appellate and revisional authority not to proceed in 
certain cases 
 
12 Revocation of certificate of settlement  
13 Information to be sent to the authorities under the relevant Act  
14 No refund of amount paid under the Act  
15 Power to make rules  
16 Power to remove difficulties  
 Schedule  Substituted  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
GOVERNMENT OF GOA 
Department of Law and Judiciary 
Legal Affairs Division  
Notification 
7/15/2009-LA 
The Goa (Recovery of Arr ears of Tax through Settlement) Act, 2009 (Goa Act 17 of 
2009), which has been passed by the Legislative Assembly of Goa on 6 -8-2009 and 
assented to by the Governor of Goa on 20 -8-2009, is hereby published for general 
information of the public. 
Sharad G. Marathe, Joint Secretary (Law). 
Porvorim, 25th August, 2009. 
_______ 
 
The Goa (Recovery of Arrears of Tax through Settlement) Act, 2009 
(Goa Act 17 of 2009)  [20-8-2009] 
AN 
ACT 
to provide for the expeditious enforcement of payment of arrears of tax relating  to the 
period upto 1[31st of March, 20 15], under  Sales Tax Law, Central Sales Tax Law, 
2[Value Added Tax Law, Entertainment Ta x Law, Luxury Tax Law and Entry Tax Law] , 
as in force in the State of Goa, by way of Settlement and matters connected therewith. 
Be it enacted by the Legislative Assembly of Goa in the Sixtieth Year of the Republic 
of India as follows:— 
1. Short title, extent and commencement .— (1) This Act may be called the Goa 
(Recovery of Arrears of Tax through Settlement) Act, 2009. 
(2) It shall extend to the whole of the State of Goa.  
(3) It shall come into force at once. 
2. Definitions.— (1) In this Act, unless the context otherwise requires—  
                                                 
 
1 In place of expression “31st of March, 2005” substituted vide Amendment Act 15 of 2016. 
2 In place of expression “Luxury Tax Law and Entry Tax Law” substituted vide Amendment Act 15 of 2016. 
 
 
(a) “applicant” means an applicant referred to in sect ion 5 and includes “dealer” or 
3[hotelier or proprietor], his legal heir, successor, assignee, or nominee; 
4[(b) “arrears of tax, penalty and interest” means,—    
(i) tax, by whatever name called, payable by a dealer or a hotelier upon 
assessment or otherwise under the relevant Act in respect of the specified period; or 
(ii) penalty imposed upon dealer or a hotelier, for the default in furnishing returns 
and/or payment of tax, in accordance with the provisions of the relevant Act, in 
respect of the specified period; or 
(iii) interest payable by a dealer or a hotelier under the relevant Act for default in 
payment of tax or delay in payment of tax, beyond the specified time, in respect of 
the specified period;] 
(c) “Commissioner” means  the  Commissioner as referred to in the relevant Act; 
(d) “dealer” means the dealer defined in section 2 of  5[Goa Sales Tax Act, 1964 
(Act 4 of 1964) or the Goa Value Added Tax Act, 2005 (Goa Act 9 of 2005)]; 
(e) “designated authority” means the authority specified in section 3; 
6[(ee) “Form” means a Form appended to this Act;] 
(f) “Government” means the Government of Goa; 
(g) “hotelier” means the hotelier defined in section 2 of the Goa Tax on Luxuries 
Act, 1988 (Act 17 of 1988); 
(h) “prescribed” means prescribed by rules made under this Act; 
7[(hh) “proprietor” means the p roprietor defined in section 2(q) of the Goa 
Entertainment Tax Act, 1964 (Act 2 of 1964) or section 2(ii) of the Goa Tax on 
Luxuries Act, 1988 (Goa Act 17 of 1988), as the case may be;] 
 
 
 
                                                 
 
3 In place of expression “hotelier” substituted vide Amendment Act 15 of 2016. 
4 Clause (b) of Section-2  substituted vide Amendment Act 15 of 2016.Orignal provision read as follows:- “(b) “arrears of 
tax, penalty and interest” means,— (i) tax, by whatever name called, payable by a dealer or a hotelier upon assessment or 
otherwise under the relevant Act in respect of the specified period; or (ii) penalty imposed upon dealer or a hotelier, for the 
default in furnishing returns and/or payment of tax, in accordance with the provisions of the relevant Act, in res pect of the 
specified period; or (iii) interest payable by a dealer or a hotelier under the relevant Act for default in payment of tax or  
delay in payment of tax, beyond the specified time, in respect of the specified period;” 
5 In place of expression “Goa Sales Tax Act, 1964 (Act 4 of 1964)” substituted vide Amendment Act 15 of 2016. 
6 Inserted vide Amendment Act 15 of 2016. 
7 Inserted vide Amendment Act 15 of 2016. 
 
 
8[(i)  “relevant Act” means,— 
(i) the Goa Sales Tax Act, 1964 (Act 4 of 1964); or 
(ii) the Goa Tax on Luxuries Act, 1988 (Act 17 of  1988); or 
(iii) the Central Sales Tax Act, 1956 (Central Act 74 of 1956); or 
(iv) the Goa Tax on Entry of Goods Act, 2000 (Act 14 of 2000), the rules and the 
Notifications issued thereunder;] 
(j) “specified period” means any period of assessment upto the financial year ending 
on 9[31st day of March, 2015] 
(2) Unless there is anything repugnant to the subject or context, all words and 
expressions used in this Act, which are not defined herein, but  defined or used in the 
relevant Act, shall have the same meaning as respectively assigned to them in the relevant 
Act. 
3. Designated authority.— For carrying out the purposes of this Act, the authorities 
referred to in section 13 ( 2) (a) and 13 ( 2) (b) of the Goa Value Added Tax Act, 2005 
(Act 9 of 2005), or such other authority as the Commissioner may, under the relevant Act, 
by order made in that behalf nominate, shall be the designated authority and such   
authority shall have jurisdiction over such are a or areas, as exercised by it under the 
relevant Act. 
10[4. Eligibility for settlement. — Subject to the other provisions of this Act, an 
applicant shall be eligible to make an application for settlement of his arrears of 
assessed tax, interest or penalty for the specified period in respect of which 
dispute is raised before an authority including the appellate authority or Court on 
or before the 31st day of March, 2016:  
Provided that no application for settlement shall be entertained if the appellate 
or re visional authority or Court has remanded the case back to the assessing 
                                                 
 
8 Clause (i) of Section -2  substituted vide Amendment Act 15 of 2016. Orignal provision read as follows: - “(i) “relevant 
Act” means,— (i) the Goa Sales Tax Act, 1964 (Act 4 of 1964); or (ii) the Goa Tax on Luxuries Act, 1988 (Act 17 of 1988); 
or (iii) the Central Sales Tax Act, 19 56 (Central Act 74 of 1956); or (iv) the Goa Tax on Entry of Goods Act, 2000 (Act 14 
of 2000), the rules and the Notifications issued there under; 
9 In place of expression “31st day of March, 2005” substituted vide Amendment Act 15 of 2016. 
10 Section-4 substituted vide Amendment Act 15 of 2016. Orignal provision read as follows: - “4. Eligibility for 
settlement.— (1) Subject to the other provisions of this Act, an applicant shall be eligible to make an application for 
settlement of his arrears of tax, interest or penalty for the specified period where the amount in arrears does not exceed Rs. 
20.00 lacs (Rupees Twenty lacs) per assessment, whether such amount is disputed in appeal, revision or review filed under 
the relevant Act or not:  
Provided that where any appellate or revisional authority or any Court has remanded the case back to the 
assessing authority for fresh assessment and such assessment has not been comp leted as on the date of commencement of 
this Act, such case shall not be taken for settlement under this Act.”; 
 
 
authority for fresh assessment and such  assessment has not been completed as on 
31st day of March, 2015:  
Provided further that the cases already decided or settled before the 
commencement of the Goa (Recovery of Arrears of Tax through Settlement) 
(Amendment) Act, 2016, shall not be taken up.] 
5. Application by the applicant .— (1) An application for the purpose of section 4 
shall be made by an applicant to the designated authority  11[in Form I hereto before 
expiry of three months, from the date of coming into force of the Goa (Recovery 
of Arrears of Tax through Settlement) (Amendment) Act, 2016]or by such extended 
date as the Government may, by notification in the Official Gazette, specify.  
12[(1A) The application under sub -section (1) shall be made through electronic 
system, by using a system code availed from the appropriate assessing authority. 
The applicant shall enter the details in accordance with the instructions that are 
applicable for making such application through electronic system. 
 (1B) Upon making application through the electronic system, the system shall 
generate an acknowledgement, the printed copy of which shall be signed and 
verified by the applicant and submitted to the d esignated authority by such date as 
may be mentioned in the acknowledgement, failing which, the application shall be 
summarily rejected.] 
(2) The designated authority shall verify the correctness of the particulars furnished in 
the application, with reference to the records available with the assessing authority or any 
other authority with whom such records may be available, as the case may be. 
(3) An applicant shall make application separately for each year under each of the Acts 
specified in clause (i) of section 2. 
6. Determination of amount payable for settlement of arrears .— (1) Where the 
designated authority is satisfied about the correctness of the particulars set forth in the 
application made by the applicant, he shall, by  order in writing, determin e the amount 
payable by the applicant for the purpose of settlement of arrears of tax, interest and 
penalty at the rates specified in section 7: 
Provided that the amount determined and payable by the applicant under this  
sub-section shall be rounded off to the nearest ten rupees. 
                                                 
 
11 In place of expression “ in the Form specified in Part A of the Schedule hereto before expiry of three months, from the 
date of coming into force of this Act” substituted vide Amendment Act 15 of 2016. 
12 Sub-section 1A and 1B inserted vide Amendment Act 15 of 2016. 
 
 
13[(2) After the amount payable by the applicant is determined under sub-section (1) by 
the designated authority, the designated authority shall inform the same to the applicant in 
Form specified in Part B of the Schedule hereto. Th e applicant shall pay the amount 
within fifteen days from the date of receipt of the intimation, by challan, duly certified 
and issued by the designated authority, and submit a receipted copy thereof to the 
designated authority.  
Provided that an applicant  being a dealer, whose appeal is pending before the 
tribunal as on the 31st day of March, 2016 and who has paid fifty percent of the 
disputed amount of tax, interest and penalty in accordance with sub -section (2) of 
section 36 of the Goa Value Added Tax Ac t, 2005 (Goa Act 9 of 2005), shall pay 
the balance amount, if any, by using e -challan and submit to the designated 
authority a self -attested photocopy of such challan in proof of payment of the 
amount as determined and intimated by the designated authority in Form II:  
Provided further that, where the designated authority is satisfied that the 
applicant being a dealer, whose appeal is pending before the tribunal as on the 
31st day of March, 2016, has paid fifty per cent of the disputed amount of tax, 
interest and penalty in accordance with sub -section (2) of section 36 of the Goa 
Value Added Tax Act, 2005 (Goa Act 9 of 2005) and that there is no further 
amount payable for the purpose of settlement at the rates specified in section 7, he 
shall issue a certifi cate of settlement in Form III hereto to the applicant and 
thereupon, such applicant shall be discharged from his liability to make payment 
of the balance amount of arrears of tax, interest and penalty to which he was liable 
before settlement.]  
14[7. Rate applicable in determining the amount payable. — Where the 
arrears of tax, interest and penalty have arisen on account of any order of 
                                                 
 
13 Sub Section(2)  of Section-6  substituted vide Amendment Act 15 of 2016.Orignal provision read as follows:- “(2) After 
the amount payable by the applicant is determined under sub -section (1) by the designated authority, the designated 
authority shall inform the same to the applicant in Form specified in Part B of the Schedule hereto. The applicant shall pay 
the amount within fifteen days from the date of receipt of the intimation, by challan, duly certified and issued by the 
designated authority, and submit a receipted copy thereof to the designated authority.” 
14 Section-7 substituted vide Amendment Act 15 of 2016. Orignal provision read as follows: - “7. Rate applicable in 
determining the amount pay able.— The amount payable by an applicant for settlement of arrears of tax, interest and 
penalty shall be as follows: — (a) Where the arrears of tax have arisen on account of any order of assessment relating to 
the specified period and where no review or ap peal or revision is preferred against the said order on the date of 
commencement of this Act, at the rate of 50% of the arrears of tax and interest only and any penalty levied thereof shall be 
waived fully. (b) Where the arrears of tax, interest and penalty arisen on account of any order of assessment relating to the 
specified period is disputed, either in review or in appeal or in revision or in any other suit or in Writ Petition, filed be fore 
any Court of Law, on the date of commencement of this Act, such  arrears shall be settled at the rate of 50% of the arrears 
of tax and 25% of the interest only and any penalty levied thereof shall be waived fully. (c) Where the arrears are of post- -
assessment interest and penalty, the applicant shall pay 50% of the po st- -assessment interest only and the penalty levied 
thereof shall be waived fully. (d) Where the arrears have arisen due to non receipt of declaration forms or declaration 
certificates, such as, Form „C‟, Form „D‟, Form „E-I/E-II‟, Form „F‟, Form „H‟ or certificates of exemption in Form ST XI 
 
 
assessment relating to the specified period which is disputed either in review or in 
appeal or in revision or in any other suit or in Writ Petition filed before any Court 
of Law, on or before the 31st day of March, 2016, such arrears shall be settled at 
the rate of 50% of the disputed amount.] 
 8. Settlement of arrears and issue of certificate of settlement.— (1) The designated 
authority, on being satisfied that the applicant has paid the amount determined under 
section 6, shall issue a certificate of settlement  15[in Form III]hereto, to the applicant and 
thereupon, such applicant shall be discharged from his liability to make payment of the 
balance amount of arrears of tax, interest and penalty  to  which he was liable before 
settlement. 
(2) The designated authority may, by Order, for reaso ns to be recorded in writing, 
reject the application of the applicant on the ground that no question of settlem ent arises 
or rectify or amend the certificate of settlement issued under sub-section (1): 
Provided that no order adversely affecting the applica nt shall be passed without giving 
him a reasonable opportunity of being heard: 
Provided further that an appeal against the order of the designated authority shall lie to 
the Commissioner and such appeal shall be made within a period of sixty days from the 
date of such order. 
9. Bar on re -opening of settled cases. — A certificate of settlement issued under  
sub-section (1) of section 8 shall be conclusive as to the settlement to which the dispute 
relates, and no matter covered by such certificate of settlemen t shall be re -opened in any 
proceeding or review or revision, or in any other proceeding, under the relevant Act. 
10. Withdrawal of review application, appeal and revision .— Notwithstanding 
anything to the contrary contained in any provision in the relevant Act, the review, appeal 
or revision for any period pending before the reviewing, appellate or the revisional 
authority, as the case may be, in respect of which a certificate of settlement is issued 
under sub -section ( 1) of section 8, shall be deemed to h ave been withdrawn by the 
applicant from the date of making of the application under sub-section (1) of section 5. 
11. Reviewing, appellate and revisional authority not to proceed in certain 
cases.—  No assessing authority, reviewing authority, appellate a uthority or revisional 
authority shall proceed to decide any assessment ,  review, appeal or  revision under the 
relevant Act relating to any period in respect of which an application has been made 
under section 5 of this Act: 
                                                                                                                                      
 
A or ST XI B, such arrears shall be settled at the rate of 50% of the arrears of tax only and the applicant shall be 
discharged from his liability of payment towards interest and penalty to which he was liable before settlement.” 
15 In place of expression “in form as specified in Part C of the Schedule” substituted vide Amendment Act 15 of 2016. 
 
 
Provided that such authority shall proceed to decide such assessment, review, appeal or 
revision for such period in accordance with the provisions of the relevant Act, if a 
certificate of settlement referred to in sub -section ( 1) of section 8 is refused to the 
applicant by an order pas sed by the designated authority in writing under sub -section (2) 
of section 8. 
12. Revocation of certificate of settlement. — (1) Notwithstanding anything 
contained in sections 9 and 10, where it appears to the designated authority that an 
applicant has obt ained the benefit of settlement under this Act by suppressing any 
material information or particulars or by furnishing any incorrect or false information or 
particulars, such designated authority may, within one year from the date of  issue of such 
certificate, for reasons to be recorded in writing and after giving the applicant a 
reasonable opportunity of being heard, revoke the certificate of settlement issued under 
sub-section (1) of section 8. 
(2)  If a certificate of settlement is revoked under sub -section ( 1), the assessment, 
review, appeal or revision, as the case may be, under the relevant Act, covered by such 
certificate of settlement, shall, notwithstanding the provisions of sections 9 and 10, stand 
revived or reinstated immediately upon such revoc ation, and such assessment, review, 
appeal or revision shall be decided in accordance with the provisions of the relevant Act, 
as if no settlement of the arrears of tax, penalty or interest in dispute in such review, 
appeal or revision has ever been made under this Act. 
13. Information to be sent to the authorities under the relevant Act .— The 
designated authority shall keep the assessing authority, the reviewing authority, the 
appellate authority or the revisional authority, who, for the time being, has ju risdiction 
over the applicant under the relevant Act, informed, inter alia of— 
(a) making of an application by an applicant under section 5;  
(b) passing of any certificate or Order by the designated authority under section  
8; or 
(c) revocation of any cer tificate of settlement under section 12, in such form and 
manner, and within such time, as the Commissioner may, by notification in the Official 
Gazette, specify. 
14. No refund of amount paid under the Act. — Any amount paid by an applicant 
under section 6 shall not be refundable under any circumstances: 
Provided that in case of revocation of a certificate of settlement in accordance with 
section 12, the amount paid by the applicant under section 6 shall be treated to have been 
paid under the relevant Act fo r the period for which the certificate of settlement has been 
revoked. 
15. Power to make rules .— The Government may, by notification in the Official 
Gazette, make rules, either prospectively or with retrospective effect, for carrying out the 
 
 
purposes of this Act, and such rules may provide for all or any of the matter which, under 
any provision of this Act is required to be prescribed or to be provided by rules. 
16. Power to remove difficulties.—  If any difficulty arises in giving effect to any of 
the prov isions of this Act, the Government may, by order published in the Official 
Gazette, as the occasion may require, do anything which appears to it to be necessary to 
remove the difficulty: 
Provided that no such order shall be made after expiry of two years f rom the date of 
coming into force of this Act. 
 
 
 
16[SCHEDULE   
“FORM I 
Application for Settlement 
(See section 5) 
 To, 
 The Designated Authority, 
 _____________________ 
 _____________________ 
 
I _______________ __________ Proprietor/Partner/Karta/Managing 
Director/Director/Principal Officer/duly authorized Officer/ President/Secretary/legal 
heir/Successor /assignee or nominee/myself/on behalf of an applicant, being eligible 
under section 4 of the Goa (Recovery of  Arrears of Tax through Settlement) Act, 2009, 
hereby apply for settlement of arrears of tax, penalty and interest.  
I furnish hereunder the requisite particulars :—  
(1) Reference to Certificate of Registration :  
(i) VAT TIN     :  
(ii) CST No.      :  
(iii) Entry Tax Regn. No.    :  
(iv) Luxury Tax Regn. No.   :  
(v) Pre-VAT Sales Tax No.    :  
(vi) Entertainment Tax   :  
Regn. No.  
 
(2) Name of the applicant   :  
(3) Status of the applicant   :  
(4) Name and Style of the business : or  
The trade name of the business  :  
 
(5) Address of the Business.—  
(i) Principal place of business  :  
                                                 
 
16 Schedule substituted by the Amendment Act 15 of 2016. Earlier schedule shown in the Annexure-A. 
 
 
 
(ii) Factory premises    :  
(6) Present postal address, if it is different from (5) above    :  
 
(7) Period in respect of assessment of tax, 
 interest and penal ty, to which the application  
relates (Enclose copy of the assessment  order for 
reference) 
01-04- __ to31-03- ____ Whether 
it is Sales Tax/CST/Luxury 
Tax/Entertainment Tax/Entry 
Tax/VAT:— - 
(8) Arrears of tax applied for Settlement:  
(i) Tax in arrears     :  
(ii) Interest in arrears     :  
(iii) Penalty in arrears     :                _____________ 
        Total_____________ 
(9) (i) the reference of the appeal/  
petition filed (Please enclose a copy thereof)    : 
 
(ii) Authority with which it is pending either  
for hearing or decision                                     :  
 
(iii) In case the appeal is pending before Tribunal, 
 whether fifty per cent of the disputed amount  
is already paid? If yes, furnish details. (Please  
enclose a copyies of challan)                             : 
 
 (iv) Date of presentation of appeal/review 
/revision, so pending                                      : 
 
 
 
 
 
 
 
 
 
FORM II 
Intimation to the applicant by the designated authority 
 
 
[See section 6(2)] 
 No.____________  
To, 
 ________________________________  
Partner/Proprietor/Manager/Director  of _____________________________  
Address:________________________   
Registration No. ________  under the relevant Act.  
Acknowledgement No.____________________  
Arrears in respect of period of assessment 01-04- _____ to 31-03-________  
Sir/Madam, 
With reference to your application bearing acknowledgement No. _______ dated 
_________, for the settlement of arrears of tax, interest and penalty relating to the period 
________________ received in my office on __________, you are hereby informed that 
the amount payable for settlement of arrears of tax and/or interest has been determined by 
me under sub -section (1) of section 6 of the Goa (Recovery of Arrears of Tax through 
Settlement) Act, 2009, as follows:  
(i) Arrears of tax in dispute    Rs. _____________  
(ii) Arrears of interest    Rs. _____________  
(iii) Arrears of penalty    Rs. _____________  
(iv) Amount of tax and interest determined 
 payable for settlement:-  
Tax         Rs. _____________  
Interest      Rs. _____________  
Penalty      Rs. _____________  
Total       Rs. _____________  
(Rupees __________________________________________ only)  
You are required to pay the amount by generating an e -challan within twenty day s 
from the receipt of this intimation and furnish a self -attested photocopy of the receipted 
copy thereof to this office.  
Date:       Signature  
(Seal)      Designation  
___________________________ 
(Appropriate designated authority) 
FORM III 
Certificate of settlement issued by the designated authority 
 
 
[See section 8(1)] 
On the basis of the application made by________ _______________________ (name 
of the applicant), who is carrying on/used to carry on the business in the trade, name of 
_______________________ at ___________________________(address) and who 
is/was holding R. C. (Local/Central/Luxury/Entry /Entertainment) No. 
________________ and TIN No. ________ under the _____________ (name of the 
relevant Act), it is certified that the Arrears  of tax, interest and penalty arisen for the 
assessment period ____________________ which was pending in review/appeal/revision 
before ______________ (name of the  appropriate review/appellate/ revisional authority), 
being review/appeal/revision case No. __ ______________, has been settled under sub -
section (1) of section 8 of the Goa (Recovery of Arrears of Tax  through Settlement) Act, 
2009. 
The applicant on the above application has paid a net amount of Rs. ———————
——— as final settlement, which has been accepted. 
ISSUED     this ________ day of __________.  
         Signature 
 (Seal) 
        Designation  
     (Appropriate designated authority)] 
 
Secretariat,  V. P. SHETYE, 
Porvorim-Goa. Secretary to the Government of Goa, 
Dated: 25-8-2009.  Law Department 
 (Legal Affairs Division).  
 
 
 
 
Annexure-A 
PART A 
Application for Settlement 
(See section 5)   
To, 
 The Designated Authority, 
 _____________________ 
 _____________________ 
 _____________________ 
 
I _______________________________________ _______ Proprietor/Partner/Karta/Managing Director  / Director / 
Principal Officer / duly authorized of ficer / President / Secretary / legal heir / /Successor/assignee or nominee/myself/on 
behalf of an applican t, being eligible under section 4 of the Goa (Recov ery of Arrears of Tax through Settlement) Act, 
2009, hereby apply for settlement of arrears of tax, penalty and interest. 
I furnish hereunder the requisite particulars:— 
 (1) Name of the applicant: 
 (2) Status of the applicant: 
 (3) Name and Style of the business: 
                      or 
  The trade name of the business: 
 (4) Address of the Business.— 
 (i) Principal place of business: 
 (ii) Add. place of business: 
   (iii) Factory premises:  
 (5) Present postal address, if it is different from (4) above: 
 (6) Reference to Certificate of Registration: 
 (i) VAT TIN 
 (ii) CST No. 
 (iii) Entry Tax Regn. No. 
 (iv) Luxury Tax Regn. No. 
 (v) Pre-VAT Sales Tax No. 
(7) Period in respect of assessment of tax, interest  01-04- to 31-03- 
 and penalty, to which the application relates  Whether it is   
 (Enclose copy of the assessment  Luxury Tax/ 
 order for reference.)  /Sales Tax/ 
   /Entry Tax:-     
          
(8) Arrears of tax applied for Settlement: 
 (i) Tax in arrears: 
 (ii) Interest in arrears: 
 (iii) Penalty in arrears: 
                                    __________ 
                            Total   __________ 
 
 (9) (i) Whether the arrears is disputed in the appeal/ 
/revision/review. 
 
  (ii) If yes, please give the reference of the appeal/petition 
  filed (Please enclose a copy thereof). 
  
  (iii) Authority with which it is pending either for hearing  
 or decision. 
 
  (iv) Date of presentation of appeal/review/revision, so pending. 
(10) Whether, any declaration in Form  
 C or D, Form E-I/E-II or Form F 
 or Form H or certificate in Form  
 ST XI A or ST XI B is collected 
 subsequent to assessment which C Form Rs. 
   helps to reduce the arrears of tax. D Form Rs. 
   If so, please file the said forms, E-I Form     
  alongwith the statements. Rs. 
    E-II Form     
   Rs. 
  F Form Rs. 
    H. Form Rs. 
 
 
    ST  XI A      
   Rs. 
    ST XI B Rs. 
        ................... 
         
    ................... 
 
 (11) Net amount of arrears applied for settlement 
  Tax Rs. 
 Interest Rs. 
 Penalty Rs. 
   _______ 
Total  _______ 
 
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, in terest 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: 
PART B 
Intimation to the applicant by the designated authority 
[See section 6(2)] 
                                                         
No.____________ 
To, 
______________________ 
Partner/Proprietor/Manager/Director 
of ____________________ 
Address:_______________ 
_______________________ 
 
Registration No. _________________________ under the relevant Act. 
Arrears in respect of period of assessment  01-04- to 31-03-     
 
Sir/Madam, 
With reference to your application No. _______ in Part A dated _________, for the settlement of arrears of tax, interest 
and penalty relating to the period ________________ received in my office on __________, you are hereby informed that 
the amount payable for settlement of arrears of tax and/or interest has b een determined by me under sub -section (1) of 
section 6 of the Goa (Recovery of Arrears of Tax through Settlement) Act, 2009, as follows: 
 (i)  Arrears of tax in dispute 
 (ii)Amount covered by furnishing   Turnover  Tax of declaration forms: 
     C or D Forms 
     E-I/E-II Forms 
      F Form 
  H Form  
  Certificate in Form ST XIA 
  Certificate in Form ST XI B 
    .........   ..........   ........ 
                                     Total........  ..........  ........  
(iii) Net arrears of tax  [(i) - (ii)]   Rs. .............. 
(iv) Arrears of interest  Rs. .............. 
 (v) Arrears of penalty Rs. ................ 
(vi) Amount of tax and interest determined 
 
 
       payable for settlement: Tax           Rs. 
                                        Interest     Rs. 
                                           Total .............. 
 
(Rupees  ______________________________ only) 
 
Certified challan is enclosed. You are required to pay the amount by challan by _______________ and furnish 
receipted copy of the challan to this office. 
 
Date: Signature   
(Seal Designation 
  .............................................................................. 
                 (Appropriate designated authority) 
 
 
PART C 
Certificate of settlement issued by the designated authority   
[See section 8(1)]  
On the basis of the application made by ______________ (name of the applicant), who is carrying on/used to carry on 
the business in the trade, name of _______________ _____________  at __________________ (address) and who is/was 
holding R. C. (Local/Central/Luxury/Entry) No.  _______________ ____ and TIN No. 
____________________________________ under the   _________________________ (name of the relev ant Act), it is 
certified that:— 
*(1) Arrears of tax, interest or penalty arisen on ac count of the order of assessment for the period from _________ to 
________ against which, no appeal is preferred upto _______  has been settled under sub -section (1) of section 8 of the 
Settlement of Appeals and Arrears under Goa Sales Tax, Central Sales Tax, Goa Tax on Luxuries and Goa  Tax on Entry of 
Goods Act, 2009. 
*(2) Arrears of tax, interest and penalty a risen for the assessment period ________________  which was pending in 
review/appeal/revision before __________________ (name of the appropriate review/appellate/revisional authority), being 
review/appeal/revision case No. ________________, has been settled under sub -section (1) of section 8 of the Goa 
(Recovery of Arrears of Tax through Settlement) Act, 2009. 
 The applicant on the above application h as paid a net amount of Rs............................... as final settlement, which has 
been accepted. 
ISSUED  this ________ day of  __________. 
 
 Signature   
 Designation  
 (Appropriate designated authority) 
(Seal) 
*Strike out whichever is not applicable. 
 N.B.: Endorse one copy of the settlement certificate Part A, Part B, and Part C to  the Commissioner 

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