Form Dvat 12 - Form For Furnishing Security

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Department of Trade and Taxes
Government of NCT of Delhi
Form DVAT 12
[See Rule 23]
Form for furnishing Security
1. Registration No./TIN
2. Full Name of Applicant Dealer
(For individuals, provide in order of
first name, middle name, surname)
3. Details of Security Already Submitted
S.
Purpose
Type of
In case of Bank Guarantee,
Description
Amount
Date of expiry
No.
of
security
name and address of bank
and details of
(Rs.)
(mm/dd/yy)
security
on which it is drawn
security
4. Details of Security Now Being Furnished
S.
Purpose
Type of
In case of Bank Guarantee,
Description
Amount
Date of expiry
No.
of
security
name and address of bank
and details of
(Rs.)
(mm/dd/yy)
security
on which it is drawn
security
5. Verification
I/We __________________________________________ hereby solemnly affirm and declare that the
information given hereinabove is true and correct to the best of my/our knowledge and belief and
nothing has been concealed therefrom.
Signature of Authorised Signatory
______________________________________
Full Name (first name, middle, surname)
______________________________________
Designation/Status
______________________________________
Place
Date
Day
Month
Year

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