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FORM VAT 105 [See Rules 138] RETURN

Return REF. No.:730362164

1. General Information 1.1)LVO CODE 1.2)Tax Period(Month/Quarter) 1.3)Return Type 1.4)Filing Date 1.5)TIN 1.6)Full Name of the dealer 1.7)Address of the dealer 1.8)Tax invoices issued in the month: 2. Particulars of Turnover Local 2)Total TO 2.1)Ret., disc., lab. chg. etc rel. to sales of the month 2.2)Const. Sales/C.A. Sales 2.3)Tax Coll.(VAT) 2.4)Exempted Sales 2.5)Others 2.6)Taxable TO (Local) [Box 2 less (Box 2.1 to Box 2.5)] Inter State 9847523)Total TO(Interstate/Export) 03.1)Ret., disc.,lab. chg, etc. 03.2)ST / Cons. Sales 479593.3)Exempted Sales 17193.4)Direct Exports 3.5)Deemed Exports (against H0 Form) 9350743.6)Sales in Transit (E-I, E-2) 3.7)Sales in the course of import (including High Sea Sales) 3.8)CST Collected 3.9)Taxable turnover (Interstate) [Box No. 3 less (Total of Box 3.1 to Box 3.8)] 4. Net Tax Payable 4.1)Output Tax Payable (Refer Box No.8.3) 4.2)B/f credit of input tax of previous month (Refer Box 4.10) 4.3)Input tax credit (Refer Box No. 11) 4.4)Tax Payable [Box No.4.1-(Box No.4.2+Box No.4.3)] 4.5)Tax deducted at source(Certificate/s Enclosed) 4.6)Tax already paid in the original/revised/corrected return & IT Adjst. of Prev. 6 months 4.7)Balance Tax Payable [Box No.4.4-(Box.No.4.5+Box.No.4.6)] 4.8)Adjustment of any excess credit towards KST/KTEG/KSTECG 4.9)Refund 4.10)Credit/excess payment carried forward 4.11)Net Tax refund as per Inc. Notf. 5. Tax Payment Details Details 5.1)Tax Payable as per Box. No. 4.7 5.2)Interest 5.3)Others 5.4)Total of Box No. 5.1 to Box No 5.3 0 0 0 0 0 0 0 0 0 0 140 JUL-2011 ORIGINAL 20/08/2011 29160562330 SIDVIN PHARMA NO.1031, 20TH CROSS,,5TH BLOCK, RAJAJINAGAR, BANGALORE-560010

Amount 47959 5792 37668 4499 0 0 4499 0 0 0 0

Amount 4499 0 0 4499

6. Details of Local Sales/ URD Purchases and Output Tax/Purchase Tax Payable 6.11)O/p tax 6.1)Taxable TO of sales at 1 % 0 0Payable(rel. to BNo.6.1) 6.12)O/p tax 6.2)Taxable TO of sales at 4% 0 0Payable(rel. to BNo. 6.2) 6.13)O/p tax 6.3)Taxable TO of sales at 5% 921684 0Payable(rel. to BNo.6.3) 6.14)O/p tax 6.4)Taxable TO of sales at 13.5% 0 0Payable(rel. to BNo.6.4) 6.14.1)O/p tax 6.4.1)Taxable TO of sales at 14% 13390 0Payable(rel. to BNo.6.4.1) 6.15)O/p tax 6.5)Taxable TO of sales at 15% 0 0Payable(rel. to BNo.6.5) 6.16)O/p tax 6.6)Others, if any (please specify) 0 0Payable(rel. to BNo.6.6) 6.17)O/p tax 6.7)Taxable TO of URD purc. at 5% 0 Payable(rel. to BNo.6.7) 6.18)O/p tax 6.8)Taxable TO of URD purc. at 13.5% 0 Payable(rel. to BNo.6.8) 6.18.1)O/p tax 6.8.1)Taxable TO of URD purc. at 14% 0 Payable(rel. to BNo.6.8.1) 6.19)O/p tax 6.9)Taxable TO of URD purc. at other 0 Payable(rel. to rate(specify rate) BNo.6.9) 6.20) Total O/p tax 6.10)Total (Box No.6.1 to 6.9) 935074payable (6.11 to 6.19) 7. Details of Interstate Sales(ISS) and CST Payable 7.1)Taxable TO of ISS at 1% 7.2)Taxable TO of ISS against C Forms at 2% 7.3)Taxable TO of ISS without C Forms at 1% 7.4)Taxable TO of ISS without C forms at 4% 7.5)Taxable TO of ISS without C forms at 5% 7.6)Taxable TO of ISS without C forms at 13.5% 7.6.1)Taxable TO of ISS without C forms at 14% 7.7)Taxable TO of ISS without C forms at 15% 7.8)Others, if any (Specify Rate of Tax) 7.9)Total (of BNo. 7.1 to 7.8)

46084

1875

47959

7.10)O/p tax payable(rel. to BNo. 7.1) 7.11)O/p tax payable(rel. to 0 BNo. 7.2) 7.12)O/p tax payable (rel. to 0 BNo. 7.3) 7.13)O/p tax payable (rel. to 0 BNo. 7.4) 7.14)O/p tax payable (rel. to 0 BNo. 7.5) 7.15)O/p tax payable (rel. to 0 BNo. 7.6) 7.15.1)O/p tax payable (rel. to 0 BNo. 7.6.1) 7.16)O/p tax payable (rel. to 0 BNo. 7.7) 7.17)O/p tax payable (rel. to 0 BNo.7.8) 7.18)Total o/p tax 0payable(Total of 7.10 to 7.17) 0

0 0 0 0 0 0 0 0 0 0

8.1)Total Output Tax (Total of BNo. 6.20 and BNo. 7.18)

47959

8.2)Output Tax deferred to Industries as per Incentive Notifications 8.3)Net Output Tax Payable (BNo. 8.1 - BNo. 8.2) 9. Details of Purchases and Input Tax 9.14)Input tax (rel. to BNo. 9.1) 9.15)Input tax (rel. to 9.2)Net value of purchases at 4% 0 0 BNo. 9.2) 9.16)Input tax (rel. to 9.3)Net value of purchases at 5% 312772 388160 BNo. 9.3) 9.17)Input tax (rel. to 9.4)Net value of purchases at 13.5% 0 0 BNo. 9.4) 9.17.1)Input tax (rel. 9.4.1)Net value of purchases at 14% 13528 5190 to BNo. 9.4.1) 9.18)Input tax (rel. to 9.5)Net value of purchases at 15% 0 0 BNo. 9.5) 9.19)Input tax (rel.to 9.6)Others, if any (pl.specify) 0 0 BNo. 9.6) 9.7)Value of URD purc. to the ext. used/sold during the Month/Quarter 9.1)Net value of purchases at 1% 0 0 9.7.1)B/F from Prev. period 9.7.2)Rel. to Curr.period 9.7.3)Total (9.7.1+9.7.2) 9.8)Value of URD purc. to the ext. not used/sold 9.8.1)B/F from Prev. period 9.8.2)Rel. to Curr. tax period 9.8.3)Total (9.8.1+9.8.2) 9.9)Val. of VAT exempted goods. 9.10)value of Purchase from Composition dealer 9.11)Val of goods imp/purc. in the course of Import/Export/Interstate trade including E-I & E-II purchases 9.12)Val of goods received by stock transfer/consignment transfer 9.13)Total value of purchases (BNo. 9.1 to 9.6,9.7.2,9.8.2 and 9.9 to 9.12) 9.13.1) Aggregate of net purchase price of goods brought which will not be considered to arrive at total or taxable purchase (Optional) 0 0 0 1190 0 0 0 720840 0 9.22)Total input tax (BNo 9.14 to 9.20) 9.21)Input tax carried forward (rel. to BNo. 9.8.3) 0 0 0 0 9.20)Input tax (rel. to BNo. 9.7.3) 0 0 0 15639 0 1894 0 0

0 47959

0 0 19408 0 727 0 0

37668

10. Ineligible Input Tax Credit 10.1)Non-deductible input tax being restricted u/s 11 10.2)Non-deductible input tax-pre-registration purchases u/s 13 of VAT Act 10.3)Non-deductible input tax-under special rebating scheme u/s 14 read with Section 11 10.4)Non-deductible input tax-under partial rebating scheme u/s 17 of VAT Act 10.5)Non-deductible input tax relating to return of goods purchased 10.6)Others, Please Specify 10.7)Total Ineligible Input Tax Credit (BNo.10.1 to 10.6) 11. Eligible Input Tax Credit [BNo. 9.22 - BNo. 10.7] Payment Details Remarks: PAY_MODE Ref. No. Date Bank Total REMARKS

0 0 0 0 0 0 0 37668

Cheque

731523

20/08/2011

KARNATAKA BANK

4499

I/We hereby declare that the particulars furnished above are true and complete in all respects. Date:................. Place:................ Signature:..................................... Name and designation:...................