Form Dvat 21-Delhi Value Added Tax Refund Claim Form Page 2

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6. 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
Instructions for filling Refund Form (DVAT-21)
1. Please fill only those claims for refund of tax, penalty or interest due under the Act which have not
already been claimed in the return.
2. Please attach a certified copy of judgment or order in case the refund arises out of a judgment of a
Court or an order of any authority under the Act.

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