Professional Documents
Culture Documents
Yes No
3. Any activities in this Tax Period?
Value SD VAT
Nature of Supply Note
(a) (b) (c)
From Turnover
19
Tax Units
Goods/Service Not Admissible for Credit
From
(Local Purchase)
Unregistered 20
Entities
Goods/Service
Not Admissible for
Credit (Taxpayers
Local Purchase 21 7,05,45,810.00
who sell only
Exempted/
Specific VAT and
Goods/Service
Other than
Standard Rate/
Import 22
Credits not taken
within stipulated
time)
Total Input Tax Credit 23 8,50,27,300.72
PART - 5: INCREASING ADJUSTMENTS (VAT)
Adjustment Details Note VAT Amount
Due to VAT Deducted at Source by the Supply
24 52,90,936.00
Receiver
Requested Amount
67
for Refund (VAT)
Requested Amount 68
for Refund (SD)
Signature
[Not required for electronic submission]
Sub-form of Part - 3.3: Exempted Goods/Service
Goods / Service
Goods / Service Value* SD VAT
Commercial Goods / Service Name Notes
Code* (a) (b) (c)
Description*
TOTAL 44,35,74,600.00 0 0
Goods / Service
Goods / Service Value* SD VAT
Commercial Goods / Service Name Notes
Code* (a) (b) (c)
Description*
Page 6 of 18
BoE
Office
Code Goods /
Base
BoE BoE (Custom BoE Item CPC Service Goods / Service Goods / Assessab SD* VAT*
Data Source * Value of AT Notes
Number Date s No Code Commercial Code* Service Name le Value (b) (c)
VAT* (a)
House / Description*
Station
Code)
Parts And
Accessories, Nes,
MCH-10/02/2
BoE Data 100275 02/02/2022 101 2 4000 Acc 9033.00.00 For Machines, 1,75,302.59 1,92,832.85 0 28,924.93 9,641.64
022
Appliances, Etc, Of
Chapter 90
MEDICAL
EQUIPMENT
Ultrasonic Scanning MCH-10/02/2
BoE Data 100275 02/02/2022 101 1 4000 ULTRASOUND 9018.12.00 44,65,830.96 45,10,489.27 0 0 2,25,524.46
Apparatus 022
MACHINE:
MODEL -EP1Q
Other electric
conductors for a
JATRABARI-1
BoE Data 141172 20/02/2022 101 4 4000 USB/Cable 8544.42.00 voltage not 8,765.04 13,463.10 2,243.85 2,019.47 673.16
3/02/22
exceeding 1,000 V:
Fitted with conn
Optical media:
JATRABARI-1
BoE Data 141172 20/02/2022 101 3 4000 Software/CD 8523.49.29 Incorporating 8,765.04 11,219.25 0 1,682.89 560.96
3/02/22
computer software
Sub-form of Part - 4.21: Goods/Service Not Admissible for Credit (Taxpayers who sell only Exempted/Specific VAT and Goods/Service Other than Standard
Rate/Credits not taken within stipulated time) - Local Purchase
Goods / Service
Goods / Service Value* SD VAT
Commercial Goods / Service Name Notes
Code* (a) (b) (c)
Description*
Sub-form of Part - 5.24: Due to VAT Deducted at Source by the Supply Receiver
S.P Trading
Dhaka 13,013.00 976.00
House
Page 7 of 18
VAT VAT Tax
Invoice Tax
Deduction at Deduction at Deposited Tax
Supplier’s Supplier’s Supplier’s Deducted No./ Invoice/Bill Deposited
Value* Source, Source, Serial no. Deposited Notes
BIN Name* Address* VAT* Challan/Bill Date Account
Certificate Certificate of Book Date
No. etc. Code
No. Date Transfer
Diganta
00202021
Printing & Dhaka 34,84,228 2,61,317.00
1-0
Packaging
Ekhwanus
Dhaka 427.00 32.00
Safa
BMTF
Dhaka 6,093.00 457.00
LIMITED
Esco
Lifesciences
Dhaka 26,093.00 1,957.00
(Banglades
h) Pvt. Ltd.
Exon
00079022 Technologi
Dhaka 27,200.00 2,040.00
8-0 es and
Services Ltd
Fann
00233039
Industries Dhaka 19,427.00 1,457.00
7-0
Ltd
Fouad
Engineerin 51160 51,160.00 3,837.00
g Works
Fresenius
Medical
Care Dhaka 2,15,680.0 16,176.00
Bangladesh
Ltd
Fresenius
Medical
Care Dhaka 6,76,293.0 50,722.00
Bangladesh
Ltd.
Future
00024023
Business Dhaka 30,480.00 2,286.00
4-0
Vision
Bio Accro
Internation Dhaka 30,587.00 2,294.00
al
Page 8 of 18
VAT VAT Tax
Invoice Tax
Deduction at Deduction at Deposited Tax
Supplier’s Supplier’s Supplier’s Deducted No./ Invoice/Bill Deposited
Value* Source, Source, Serial no. Deposited Notes
BIN Name* Address* VAT* Challan/Bill Date Account
Certificate Certificate of Book Date
No. etc. Code
No. Date Transfer
GE
00027111 Healthcare
Dhaka 3,71,427.0 27,857.00
1-0 Bangladesh
Ltd.
General
Elevator
Dhaka 13,080.00 981.00
Corp.
Bangladesh
Genesis
Internation Dhaka 49,520.00 3,714.00
al
00285571 ABC
Dhaka 14,01,613 1,05,121.00
2-0 Corporation
00123120 Genetic
Dhaka 27,06,333 2,02,975.00
5-0 Trading.
Genomic
Dhaka 50,640.00 3,798.00
Health Care
Global Lift
& Escalator Dhaka 6,093.00 457.00
Ltd.
Global Lift
Dhaka 33,040.00 2,478.00
Co. Ltd.
Globex
00025544 Marketing
Dhaka 26,347.00 1,976.00
4-0 Company
Ltd.
Healthcare
Diagnostic
Dhaka 29,360.00 2,202.00
Solution
Ltd.
BIO TEST
INTERNATI Dhaka 3,533.00 265.00
ONAL.
Hospitech
Dhaka 65,000.00 4,875.00
Essentials
Page 9 of 18
VAT VAT Tax
Invoice Tax
Deduction at Deduction at Deposited Tax
Supplier’s Supplier’s Supplier’s Deducted No./ Invoice/Bill Deposited
Value* Source, Source, Serial no. Deposited Notes
BIN Name* Address* VAT* Challan/Bill Date Account
Certificate Certificate of Book Date
No. etc. Code
No. Date Transfer
Ibn Sina
Dhaka 8,58,813.0 64,411.00
Trust
Idea
Communic Dhaka 64,000.00 4,800.00
ation
Internation
al Office
Dhaka 29,600.00 2,220.00
Machines
Ltd.
Access
telecom Dhaka 28,866.00 2,165.00
(bd) ltd
Isra
Dhaka 1,173.00 88.00
Enterprise
Janani
Printing Dhaka 56,240.00 4,218.00
Press
Khandaker
Computers Dhaka 37,600.00 2,820.00
& Printers
Lab Care
Trade
Dhaka 3,413.00 256.00
Internation
al.
M.T.
Internation Dhaka 8,653.00 649.00
al
Bio-Trade
00192953
Internation Dhaka 2,85,91,81 21,44,386.0
9-0
al
Mahbub
Dhaka 36,573.00 2,743.00
Murshid
Masro
00010790 Printing &
Dhaka 1,00,147.0 7,511.00
2-0 Packaging
Ltd.
Page 10 of 18
VAT VAT Tax
Invoice Tax
Deduction at Deduction at Deposited Tax
Supplier’s Supplier’s Supplier’s Deducted No./ Invoice/Bill Deposited
Value* Source, Source, Serial no. Deposited Notes
BIN Name* Address* VAT* Challan/Bill Date Account
Certificate Certificate of Book Date
No. etc. Code
No. Date Transfer
Medi
00078367
Graphic Dhaka 1,49,200.0 11,190.00
7-0
Trading Ltd.
MEDICO
INTERNATI Dhaka 32,387.00 2,429.00
ONAL
MediSensor
Technology
Dhaka 38,093.00 2,857.00
Incorporate
d
ADN
00033362
Telecom Dhaka 18,586.00 1,394.00
1-0
Ltd.
Meditech
00185875
Imaging Dhaka 61,43,998 4,60,800.00
2-0
Ltd.
Medlife
Healtcare Dhaka 47,213.00 3,541.00
Ltd
Medtronic
Bangladesh Dhaka 16,507.00 1,238.00
Pvt.Ltd.
Meghna
00008893 Pulp &
Dhaka 2,09,521.0 15,714.00
6-0 Paper Mills
Ltd.
Bio-
Vascular
Dhaka 1,36,000.0 10,200.00
Internation
al
Meghna
Pulp &
Dhaka 30,360.00 2,277.00
Paper Mills
Ltd.
Merza
Dhaka 5,867.00 440.00
Surgical
Page 11 of 18
VAT VAT Tax
Invoice Tax
Deduction at Deduction at Deposited Tax
Supplier’s Supplier’s Supplier’s Deducted No./ Invoice/Bill Deposited
Value* Source, Source, Serial no. Deposited Notes
BIN Name* Address* VAT* Challan/Bill Date Account
Certificate Certificate of Book Date
No. etc. Code
No. Date Transfer
Microbiotec
Dhaka 39,493.00 2,962.00
h
Mohsin
Dhaka 1,613.00 121.00
Enterprise
MRZ
Healthcare Dhaka 24,387.00 1,829.00
(Pvt) Ltd.
Al-Fatah
Internation Dhaka 2,00,627.0 15,047.00
al
Munira
Dhaka 13,907.00 1,043.00
Industries
Nexus
Label &
Dhaka 3,533.00 265.00
Printing
Limited
Nipro JMI
Marketing
Dhaka 1,38,960.0 10,422.00
Ltd.(Renal
Unit)
00197603 Biotech
Dhaka 30,98,813 2,32,411.00
1-0 Services
Nissho
Koeki
00027453
Tissue Dhaka 2,63,040.0 19,728.00
8-0
Papers Co.
Ltd.
OnnoRoko
m solutions Dhaka 8,573.00 643.00
Ltd
Organic
Internation Dhaka 91,427.00 6,857.00
al
Page 12 of 18
VAT VAT Tax
Invoice Tax
Deduction at Deduction at Deposited Tax
Supplier’s Supplier’s Supplier’s Deducted No./ Invoice/Bill Deposited
Value* Source, Source, Serial no. Deposited Notes
BIN Name* Address* VAT* Challan/Bill Date Account
Certificate Certificate of Book Date
No. etc. Code
No. Date Transfer
Overseas
00048291 Marketing
Dhaka 9,97,706.0 74,828.00
6-0 Corporatio
n (Pvt.) Ltd.
Polycon
Dhaka 35,560.00 2,667.00
Ltd.
Quasem
00187806
Industries Dhaka 14,560.00 1,092.00
5-0
Limited
Alive
Healthcare Dhaka 14,613.00 1,096.00
Limited
RACE
00070484
ONLINE Dhaka 14,600.00 1,095.00
4-0
LIMITED
Resources -
Dhaka 3,57,200.0 26,790.00
21
Dhaka
University
Dhaka 21,739.00 3,261.00
Officers
Association
SARBAN
IMPORT Dhaka 1,06,973.0 8,023.00
LTD.
Shahban
Offset
Dhaka 2,78,040.0 20,853.00
Printing
Press
Shan
Trading Dhaka 12,707.00 953.00
Corporation
Page 13 of 18
VAT VAT Tax
Invoice Tax
Deduction at Deduction at Deposited Tax
Supplier’s Supplier’s Supplier’s Deducted No./ Invoice/Bill Deposited
Value* Source, Source, Serial no. Deposited Notes
BIN Name* Address* VAT* Challan/Bill Date Account
Certificate Certificate of Book Date
No. etc. Code
No. Date Transfer
Siemens
00025702
Healthcare Dhaka 16,17,427 1,21,307.00
8-0
Limited
Siemens
00025702
Healthcare Dhaka 58,44,133 4,38,310.00
8-0
Ltd.
Silme Bag
Industries Dhaka 79,133.00 5,935.00
Ltd.
Bashundhar
a Paper Dhaka 3,08,013.0 23,101.00
Mills Ltd.
Straight
Dhaka 71,107.00 5,333.00
home
Dialab
Internation Dhaka 11,240.00 843.00
al
Sunny
Trading
Dhaka 3,25,427.0 24,407.00
Agency Pvt.
Ltd.
Taj Surgical
Dhaka 15,173.00 1,138.00
Mart
Technokit
Healthcare Dhaka 28,573.00 2,143.00
Ltd.
Technowor
00050868 th
Dhaka 33,493.00 2,512.00
2-0 Associates
Limited.
Telnet
00038242
Communic Dhaka 16,254.00 1,219.00
1-0
ation Ltd.
00204270 The Moon
Dhaka 2,30,427.0 17,282.00
5-0 Enterprise
Page 14 of 18
VAT VAT Tax
Invoice Tax
Deduction at Deduction at Deposited Tax
Supplier’s Supplier’s Supplier’s Deducted No./ Invoice/Bill Deposited
Value* Source, Source, Serial no. Deposited Notes
BIN Name* Address* VAT* Challan/Bill Date Account
Certificate Certificate of Book Date
No. etc. Code
No. Date Transfer
ZAS
Distribution Dhaka 60,960.00 4,572.00
Co.
BDCOM
00000121
Online Dhaka 6,960.00 522.00
6-0
Limited
00028312
Diamed Dhaka 1,28,947.0 9,671.00
4-0
Titas
Scientific Dhaka 61,333.00 4,600.00
Supply
00200960 Unihealth
Dhaka 82,81,227 6,21,092.00
7-0 Limited.
00017397 Unimed
Dhaka 5,85,494.0 43,912.00
5-0 Limited
Unitrade
Multi
Dhaka 2,587.00 194.00
Corporatio
n Ltd.
Venture
Dhaka 6,093.00 457.00
Bangladesh
Walton
Dhaka 28,013.00 2,101.00
Plaza
Webns
Technology Dhaka 33,333.00 2,500.00
Ltd.
Page 15 of 18
Challan Number Date Amount VAT* Notes*
Page 16 of 18
Treasury Challan
Tax Deposited Account
Number/ Token Bank/ CGA* Branch/CAFO/DCA* Date* Amount* Notes
Code
Number*
Islami Bank
2122-00034625241 Bogra 06/03/2022 1 / 1133 / 0035 / 0311 61,575.00 Bogura
Bangldesh Ltd.
Islami Bank
2122-00035666161 Gandaria 08/03/2022 1 / 1133 / 0035 / 0311 77,631.00 Doyagonj
Bangldesh Ltd.
T32 Sonali Bank Ltd. Badda 06/03/2022 1 / 1133 / 0035 / 0311 1,49,668.00 Badda
T33 Sonali Bank Ltd. Badda 06/03/2022 1 / 1133 / 0035 / 0311 3,27,213.00 Badda
T42 Sonali Bank Ltd. Badda 06/03/2022 1 / 1133 / 0035 / 0311 22,044.00 MCU
Islami Bank
2122-00035648571 Dhanmondi 08/03/2022 1 / 1133 / 0035 / 0311 49,398.00 Trust
Bangldesh Ltd.
T43 Sonali Bank Ltd. Badda 06/03/2022 1 / 1133 / 0035 / 0311 33,208.00 MCU
T01 Sonali Bank Ltd. Custom House 09/03/2022 1 / 1133 / 0035 / 0311 4,52,340.00 Uttara
T-2 Sonali Bank Ltd. Custom House 09/03/2022 1 / 1133 / 0035 / 0311 2,44,063.00 Uttara
123 Sonali Bank Ltd. Panchlaish 09/03/2022 1 / 1133 / 0035 / 0311 5,714.00 Chattogram
Islami Bank
2122-00034900121 Comilla 06/03/2022 1 / 1133 / 0035 / 0311 1,44,674.00 Cumilla
Bangldesh Ltd.
Islami Bank
2122-00034625241 Bogra 06/03/2022 1 / 1133 / 0035 / 0311 1,82,087.00 Bogura
Bangldesh Ltd.
T-145 Sonali Bank Ltd. Malibagh 10/03/2022 1 / 1133 / 0035 / 0311 2,47,429.00 Malibagh
24 Sonali Bank Ltd. Kalyan Pur 10/03/2022 1 / 1133 / 0035 / 0311 59,400.00 Mirpur
32 Sonali Bank Ltd. Kalyan Pur 10/03/2022 1 / 1133 / 0035 / 0311 57,311.00 Mirpur
T-32 Sonali Bank Ltd. Hazaribagh 10/03/2022 1 / 1133 / 0035 / 0311 16,23,778.00 D-Lab
T6 Sonali Bank Ltd. Hazaribagh 03/03/2022 1 / 1133 / 0035 / 0311 1,72,687.00 D-Lab
Krishi Bazar
T-4 Sonali Bank Ltd. 14/03/2022 1 / 1133 / 0035 / 0311 3,68,381.00 Hospital,Dhan.
Mohammadpur
Krishi Bazar
T-4 Sonali Bank Ltd. 13/03/2022 1 / 1133 / 0035 / 0311 17,76,249.00 Hospital,Dhan.
Mohammadpur
T-25 Sonali Bank Ltd. Hazaribagh 10/03/2022 1 / 1133 / 0035 / 0311 3,267.00 IMIC
Page 17 of 18
Treasury Challan
Tax Deposited Account
Number/ Token Bank/ CGA* Branch/CAFO/DCA* Date* Amount* Notes
Code
Number*
T-26 Sonali Bank Ltd. Hazaribagh 10/03/2022 1 / 1133 / 0035 / 0311 1,95,960.00 IMIC
T-6 Sonali Bank Ltd. Kalyan Pur 13/03/2022 1 / 1133 / 0035 / 0311 29,223.00 Medical College
503 Sonali Bank Ltd. Jessore Corporate 07/03/2022 1 / 1133 / 0035 / 0311 2,82,876.00 Jashore
Islami Bank
2122-00035652031 Dhanmondi 08/03/2022 1 / 1133 / 0035 / 0311 1,12,867.00 Trust
Bangldesh Ltd.
Krishi Bazar
T-6 Sonali Bank Ltd. 09/03/2022 1 / 1133 / 0035 / 0311 4,86,774.00 ISMCH
Mohammadpur
Krishi Bazar
T-7 Sonali Bank Ltd. 09/03/2022 1 / 1133 / 0035 / 0311 46,710.00 ISMCH
Mohammadpur
13 Sonali Bank Ltd. Kalyan Pur 10/03/2022 1 / 1133 / 0035 / 0311 1,264.00 Nursing
14 Sonali Bank Ltd. Kalyan Pur 10/03/2022 1 / 1133 / 0035 / 0311 33,000.00 Nursing
Islami Bank
2122-00035665521 Gandaria 08/03/2022 1 / 1133 / 0035 / 0311 92,701.00 Doyagonj
Bangldesh Ltd.
Islami Bank
2122-00035665891 Gandaria 08/03/2022 1 / 1133 / 0035 / 0311 5,56,491.00 Doyagonj
Bangldesh Ltd.
504 Sonali Bank Ltd. Jessore Corporate 07/03/2022 1 / 1133 / 0035 / 0311 21,900.00 Jashore
T-7 Sonali Bank Ltd. Savar 09/03/2022 1 / 1133 / 0035 / 0311 50,362.00 Savar
T-12 Sonali Bank Ltd. Savar 09/03/2022 1 / 1133 / 0035 / 0311 1,30,295.00 Savar
T-1 Sonali Bank Ltd. Panchlaish 09/03/2022 1 / 1133 / 0035 / 0311 1,80,000.00 Chattogram
T-2 Sonali Bank Ltd. Panchlaish 09/03/2022 1 / 1133 / 0035 / 0311 1,68,113.00 Chattogram
145 Sonali Bank Ltd. Malibagh 10/03/2022 1 / 1133 / 0035 / 0311 1,30,400.00 Malibagh
TOTAL 85,77,053.00
Page 18 of 18