Professional Documents
Culture Documents
NAME OF TMPAYER
ASSESSMENT NO.
TAX IDENTIFICATION NUMBER
ADDRESS OF REFINERY/DEPOT/FACILITIES
DATE /TIME OF STOCKTAKING
l;7
--.:r:iii::.,jt:t!t-fr,.ili::if"rr!',:'r:i1ii:xa:31:,i:.:|.i::rii:!:ti:iii,.,!liirrri.;,f':lri; irExcise:.I.ax.Piaid
I
I
ratrxo. ' li'.. ,affesrNo),'':
ll.ir:m;
'll Iii:'; ii::lai".1;i.ii)ir ii.'11;:
I declare under penalty of perjury that the aforesaid information are true and correct'
rANlozols
ill"u
RECEIVEDT