EXTRAORDINARY

No. 2

GOVERNMENT OF GOA

Department of Finance

Office of the Commissioner of State Tax

Order

In exercise of the powers conferred under Section 8A read with Section 19 of the Goa (Recovery of Arrears

of Tax, Interest, Penalty, Other Dues through Settlement) Act, 2023 (Goa Act 34 of 2023) (hereinafter referred to

as the “said Act”), I, the Commissioner of State Tax, do hereby specify the Form Nos. IA, IIA, IVA, VA, VIA,

VIIA, XA, XIIIA, XVA, XIXA and XXA appended herein below which shall be used for the respective purposes

under the said Act and shall be filed/maintained in accordance with the provisions of said Act and in compliance

of the instructions contained in respective Forms.

S. S. Gill, IAS, Commissioner of State Taxes.

---------

FORM IA

(See sub-section (1) of Section 8A read with section 19(2) of the Goa (Recovery of

Arrears of Tax, Interest, Penalty, Other Dues through Settlement) Act, 2023)

Application for Waiver of interest and penalty u/s. 8A of GRATIPOS Act, 2023

Instructions for submission of Application for Waiver of interest and penalty

1. An online application shall be made separately for each financial year under each relevant Act.

2. The following persons can electronically sign the application for settlement:-

No. CCT/5-4/ GRATIPOS/2025-26/2520

Date : 10-Sep-2025

Suggestions are welcomed on e-mail: [email protected]

1019

Reg. No. RNP/GOA/32/2024-2026

RNI No. GOAENG/2002/6410

Panaji, 11th September, 2025 (Bhadra 20, 1947)

SERIES I No. 24

PUBLISHED BY AUTHORITY

Constitution of Business

Person who can electronically sign the application

Proprietorship

Proprietor

Partnership

Managing/Authorised Partners

Hindu Undivided Family

Karta

Private Limited Company

Managing/Whole-time Directors

Public Limited Company

Managing/Whole-time Directors

Society/Club/Trust/AOP

Members of Managing Committee

Government Department

Person In charge

Public Sector Undertaking

Managing/Whole-time Director

Unlimited Company

Managing/Whole-time Director

Limited Liability Partnership

Designated Partners

Local Authority

Chief Executive Officer or Equivalent

Statutory Body

Chief Executive Officer or Equivalent

Foreign Limited Liability Partnership

Authorised Person in India

Foreign Company Registered (in India)

Authorised Person in India

Others (specify)

Person In charge

3. Any of the above referred person who are competent to file online application for waiver may by a written

authority letter in Form VAT XXXII may authorize the Tax Practitioner/Chartered Accountant/Legal

Practitioner/Cost Accountant/Company Secretary/Employee/Relative to file such application. The scanned

copy of written authority letter shall be uploaded while filing the online application for waiver.

4. Authorised Representative shall not be a minor.

5. Only one single online application can be filed under one relevant Act for one year as per Section 8A of the

GRATIPOS Act, 2023.

□

I agree & abide with the above mentioned instructions.

The application is filed by

□ Applicant himself

□ Authorised Representative

If Authorised Representative is selected (Drop Down)

□ Sales Tax Practitioner

□ Chartered Accountant

□ Legal Practitioner

□ Cost Accountant

□ Company Secretary

□ Employee

□ Relative

□ Any other

Upload authority letter in Form VAT XXXII*

1020

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 24

(EXTRAORDINARY No. 2)

11TH SEPTEMBER, 2025

□

I hereby consent to be the Authorised Representative of the applicant and authority letter is uploaded

herewith.

Particulars of Authorized

Representative/Applicant

First Name

Middle Name

Last Name

Name

*Mobile Number: (Shall be

validated by sending OTP)

*Email address:

(Shall be validated by

sending OTP)

Telephone No.

with STD

□

I hereby undertake that any communication by way of SMS and/or email on mobile number and Email

ID of the Authorized Representative/applicant shall be treated as valid service upon the applicant.

(After successful validation of Email address and Mobile number by sending OTP, the applicant/Authorized

Representative shall be allowed to fill further details in the online Form.)

Select the relevant Act under which application is

filed

(Drop down)

Select appropriate financial year for which application is

filed. (Drop down)

□

the Goa Value Added Tax Act, 2005

{2005-06 to 2017-18}

□

the Central Sales Tax Act, 1956

{1964-65 to 2017-18}

□

the Goa Tax on Entry of Goods Act, 2000

{2000-01 to 2017-18}

□

the Goa Tax on Luxuries Act, 1988

{1988-89 to 2017-18}

□

the Goa Sales Tax Act, 1964

{1964-65 to 2004-05}

□

the Goa Entertainment Tax Act, 1964

{1964-65 to 2017-18}

□

Unregistered Dealer

{1964-65 to 2017-18}

(Note: Depending upon relevant Act selected the financial year as mentioned above shall be available in

the drop list for selection.)

Enter the Registration Number under the

relevant Act*:

(If other than VAT Act is Selected at Sr.

No.3)

If registered under VAT Act, Enter your

TIN No.

ii.

Name of the applicant:

(auto populated only in case TIN No. is entered, otherwise the

details should be entered)

iii

Legal Name of the Business:

(auto populated only in case TIN No. is entered, otherwise the

details should be entered)

iv.

Trade Name of the Business:

(auto populated only in case TIN No. is entered, otherwise the

details should be entered)

Address:

(auto populated only in case TIN No. is entered, otherwise the

details should be entered)

1021

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 24

(EXTRAORDINARY No. 2)

11TH SEPTEMBER, 2025

If Unregistered Dealer (URD):

(Following details to be entered manually)

Name of the applicant:

ii.

Legal Name of the Business:

iii.

Trade Name of the Business:

iv.

Address:

Address for Communication:

If applicant want to provide new address for communication (Enter the same)

(i) State: (Drop down)

(ii) District: (auto populated)

(iii) Taluka : (Drop down)

(iv) Village Panchayat/Municipality : (Drop down)

(v) House No.:

(vi) Floor:

(vii) Building Name:

(viii) Road Name:

(ix) Nearest land mark:

(x) Village area:

(xi) Pin Code

□

I hereby undertake that any communication sent to the Address for communication (entered at sr. no. 4

above) shall be treated as valid service upon the applicant.

Constitution of Business (Please Select the Appropriate) –

(i) Proprietorship

□

(ii) Partnership

□

(iii) Hindu Undivided Family

□

(iv) Private Limited Company

□

(v) Public Limited Company

□

(vi) Society/Club/Trust/Association of Persons

□

(vii) Government Department

□

(viii) Public Sector Undertaking

□

(ix) Unlimited Company

□

(x) Limited Liability Partnership

□

(xi) Local Authority

□

(xii) Statutory Body

□

(xii) Foreign Limited Liability

Partnership

□

(xiv) Foreign Company Registered (in India)

□

(xv) Others (Please specify)

□

The application is filed in respect of

□ Complete Financial Year

□ Part Financial Year

If Part Assessment Period (Enter date)

From

DDMMYYYY

(Note: If part financial year 2017-18 is selected than the period should be between 01-04-2017 to 30-06-2017

shall be provided in drop down.)

8. I apply under following category under section 8A for waiver of interest and/or penalty:

Where no assessment is completed and dues arising out of:

(i) Type (Select any one)

Drop Down:

□ Returns filed

□ Revised Returns filed

□ Annual Audit Report

□ Any other

1022

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 24

(EXTRAORDINARY No. 2)

11TH SEPTEMBER, 2025

(iii) Date of filing return/Report

DDMMYYYY

{Provide the date of latest return/report filed}

(iii) Reference no. if any

(iv) Details of Demand:

Tax

Interest

Penalty

Total

(Autosum)

Where assessment is completed and dues arising out of

(i) Type of Order (Select any one)

Drop Down:

□ Assessment Order

□ Rectification Order

□ Review Order

□ Appeal order

□ Any other Order

(ii) Reference No./Order No.:

{Provide the latest Order No./Reference no.}

(iii) Date of Order

DDMMYYYY

{Provide the date of latest Order}

(iv) Original Assessment Order/Letter of Scrutiny/Appeal

Order was issued by

(Drop Down)

□ Assistant Commissioner of Commercial Tax

□ Commercial Tax Officer

□ Assistant Commercial Tax Officer

(v) Details of Demand :

Tax

Interest

Penalty

Total

(Autosum)

Where neither returns were filed nor assessment was completed of the dealer, Dues arising as per

Books of accounts of the dealer :

(i) Details of Demand :

Tax

Interest

Penalty

Total

(Autosum)

Details of 100% tax paid

□ Online

□ Over the Counter

□ (Select any one)

Details of Online Payment made

Sr. No.

E-Challan

date

E-Receipt No

E-Receipt

date

Amount of tax

paid

Payment Date

DDMMYYYY

…

Total

(Auto calculated)

1023

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 24

(EXTRAORDINARY No. 2)

11TH SEPTEMBER, 2025

Details of counter Payment made

Sr.

No.

Challan No.

Challan date

Amount of tax

paid

Payment

Date

Upload scan copy of paid challan

with bank seal

DDMMYYYY

……

Total

(Auto

calculated)

Note: Dealer should ensure that any payment made under the Budget Head other than tax should not be

entered in the payment details. Provide the details of TAX payments only.

Verification (by authorised signatory)

□

I, hereby solemnly affirm and declare that the information given herein above is true and

correct to the best of my knowledge and belief and nothing has been concealed therefrom and I

am not otherwise ineligible for making this application in terms of the provisions of said Act. If

there is any suppression of the facts or misrepresentation on my behalf, I am aware that my

application is liable to be rejected without going into the merits.

Signature

Place:

Name of Authorised Representative/ Applicant ….……………………

Date:

Designation/Status……………………………………

Save

Preview

Submit

Note: 1. Submit click shall not be enabled for this form if the total of Sr. No. 9 (a) and 9 (b) is less than

the amount declared as payable under Sr. No. 8 of this Form.

2. If payment date is after 31-12-2025 in Sr. No. 9, submit click shall not be enabled for this Form

unless the total of Sr. No. 9 (a) and 9(b) is 200 % / double the amount of tax declared as payable

under Sr. No. 8 of this Form (100 % tax amount + equal amount as late fees)

3. After online submission of this Form, the system generated acknowledgement shall be displayed.

---------

1024

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 24

(EXTRAORDINARY No. 2)

11TH SEPTEMBER, 2025

Acknowledgment for submission of application for Waiver of interest and penalty

Date:

Time:

< Application Reference Number (ARN) with date>

Your application has been successfully filed.

1. Date of filing-

2. Time of filing

3. Place of filing-

4. IP address-

5. Name of the person filing the application-

6. Email address-

7. Mobile Number-

8. Act-

9. Financial Year-

********

1025

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 24

(EXTRAORDINARY No. 2)

11TH SEPTEMBER, 2025

FORM IVA

(See sub-section (4) of Section 8A read with section 19(2) of the Goa (Recovery of Arrears of Tax, Interest,

Penalty, Other Dues through Settlement) Act, 2023)

Letter of Intimation of Waiver amount u/s. 8A

<DIN: {Auto generate upon saving the document)>

Application Reference No.

(After entering ARN the data should be auto-populated)

Name of the applicant:

Legal Name of the Business:

Trade Name of the Business:

Address:

Email Address:

Mobile Number :

Address for Communication : (Auto-populated as per Form IA)

(i) State:

(ii) District:

(iii) Taluka :

(iv) Village Panchayat/Municipality

(v) House No.:

(vi) Floor:

(vii) Building Name:

(viii) Road Name:

(ix) Nearest land mark:

(x) Village area:

(xi) Pin Code

Registration Number under the relevant Act for which

application is filed

Relevant Act under which application is filed

10.

The application is filed in respect of

□ Complete Financial Year

□ Part Financial Year

11.

Complete/Part Financial year for which application is filed

From

DDMMYYYY

12.

Where no assessment is completed and dues arising out of:

□ Returns

□ Revised Returns

□ Annual Audit Report

□ Any other

13.

Where assessment is completed and dues arising out of

□ Assessment Order

□ Rectification Order

□ Review Order

□ Appeal order

□ Any other Order

14.

Where neither returns were filed nor assessment was completed of the dealer Dues arising as per Books of

accounts of the dealer

1027

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 24

(EXTRAORDINARY No. 2)

11TH SEPTEMBER, 2025

15.

Order No.

Order Date

16. Details of demand and Amount payable for waiver benefit:

100 % tax dues amount Payable for waiver of interest/penalty benefit u/s. 8A

Particulars

Tax

Penalty

Interest

Post

Assessment

Interest

Total

a) Amount determined in Assessment (as per

Assessment/ any other Order)

b) Less: Amount paid from due date till date

of filing waiver application or 31/12/2025

c) Balance payable

d) Amount paid less/short before expiry of

time limit as per section 8A (a) minus (b)

e) Add: late fee as per sub-section (5) of

section 8A of GRATIPOS Act. {Equal to

(d)}

NIL

f) Deficit tax amount plus late fee

determined as payable {(d)+(e)}

NIL

You are required to pay the deficit amount plus equal amount as late fee determined as payable above by

generating an E-challan in Lump-sum within a period of 20 days from the date receipt of this intimation and

submit a self - attested copies of paid challan/E-receipt copy thereof in the office of the Designated

Authority.

[Note: If the last date of payment happens to be a public holiday including Sunday or Bank holiday then any

payment made on the next working day will be considered as made within the due date of payment.]

Signature

Place:

Name of Authorised Signatory ….……………………

Date:

Designation/Status……………………………………

1028

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 24

(EXTRAORDINARY No. 2)

11TH SEPTEMBER, 2025

FORM XA

[See Section 8A read with section 19(2) of the Goa (Recovery of Arrears of Tax, Interest, Penalty, Other Dues

through Settlement) Act, 2023]

Certificate of Waiver of Interest and/or penalty u/s. 8A

<DIN: {Auto generated upon saving the document}>

On the basis of the application made by______________________________ (name of the applicant) under sub

section (1) of section 8A of the Goa (Recovery of Arrears of Tax, Interest, Penalty, Other Dues Through

Settlement) Act, 2023{hereinafter referred to as ‘GRATIPOS Act’}, who is carrying on/used to carry out the

business in the trade, name of _______________________ at___________________________(address) and who

is/was holding TIN No. ________and R. C. (Sales Tax/Central/Luxury/Entry/Entertainment) No.

________________under the _____________ (name of the relevant Act), it is hereby certified that the applicant

is eligible for waiver of interest, penalty and entire post assessment interest under section 8A of the GRATIPOS

Act for the period from DDMMYYYY to DDMMYYYY under the relevant Act.

The applicant on the above application has paid an amount of Rs. —————————— as 100% tax dues,

which has been accepted. Hence entire interest and/or penalty and entire post assessment interest stands waived

u/s. 8A of the Act and the application has been accepted and dues settled under sub-section (2) of Section 8A of

the Goa (Recovery of Arrears of Tax, Interest, Penalty, Other Dues Through Settlement) Act, 2023.

ISSUED this ________ day of __________.

Signature

(Seal)

Designation

(Appropriate Designated Authority)

To,

M/s.

---------

FORM XIII A

SHOW CAUSE NOTICE

[See sub-section (6) of Section 8A read with Section 19(2) of the Goa (Recovery of Arrears of Tax, Interest,

Penalty, Other Dues through Settlement) Act, 2023]

1032

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 24

(EXTRAORDINARY No. 2)

11TH SEPTEMBER, 2025

DIN: {Auto generate upon Saving the document}

Date: {System Date (on saving)}

Ref: Your application No. {Auto populate from Form IA} dated {Auto populate from Form IA}

Whereas, the dealer/hotelier/proprietor, M/s {Name of the dealer/hotelier/proprietor – Auto populate

from Form IA} , {Full Address of the dealer – Editable Auto populate from Form IA}, having VAT TIN as {TIN

No. - Auto populate from Form IA} and {Sales Tax/CST/Entry Tax/Luxury Tax /Entertainment Tax – Auto

populate short Name of the relevant Act} R.C. No. as {R.C. No.- Auto populate from Form IA} have filed the

above referred online application under sub-section (1) of section 8A of the Goa (Recovery of Arrears of Tax,

Interest, Penalty, Other Dues Through Settlement) Act, 2023 (hereinafter referred to as the “GRATIPOS Act,

2023”) for waiver of arrears under {Name of the Act – Auto populate full Name of the relevant Act from Form -

IA} for the assessment year/period {Assessment year/period – Auto populate from Form IA}.

And whereas, upon scrutiny of the above referred application, the following defects/deficiencies are

noticed:-

You are therefore required to:-

Show cause in writing, on or before {Date= Notice Saved Date + one month –> Editable Auto populate}

as to why the above referred application should not be rejected.

Appear in person or through a duly authorized representative before the undersigned at his chamber at the

above mentioned address, on {Date Entry Field} at {Time Entry Field}.

If you fail to furnish a reply within the stipulated date or fail to appear for personal hearing on the

appointed date and time, as aforesaid, the above referred application No. {Auto populate from Form IA} dated

{Auto populate from Form IA} shall be rejected, without any further reference to you.

Given under the seal of this office.

({Name of the Designated Authority – Auto populate as per login})

Dy. Commissioner of State Tax

{Ward Name - auto populate} Ward/Head Office

Designated Authority

1033

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 24

(EXTRAORDINARY No. 2)

11TH SEPTEMBER, 2025

To,

{Name of the dealer/hotelier/proprietor – Auto populate from Form IA}

{Address of the dealer – 1st Line - Auto populate from Form IA }

{Address of the dealer – 2nd Line - Auto populate from Form I A}

TIN/R.C. No.:{TIN/R.C. No - Auto populate from Form I A}

---------

FORM XVA

ORDER

[See sub-section (9) of Section 8A read with Section 19(2) of the Goa (Recovery of Arrears of Tax, Interest,

Penalty, Other Dues through Settlement) Act, 2023]

DIN: {Auto generate upon Saving the document}

Date: {System Date (on saving)}

Ref: 1. Your application No. {Auto populate from Form IA} dated {Date-Auto populate from

Form IA}

2. Form IVA bearing DIN {DIN – Auto populate DIN of Form IVA} dated {Date-Auto

populate from Form IVA}

3. Form XIII A bearing DIN {DIN – Auto populate DIN of Form XIX A} dated {Date-

Auto populate from Form XIII A}

Whereas the Dealer/Hotelier/Proprietor M/s. {Name of the dealer/hotelier/proprietor – Auto populate

from Form IVA}, {Full Address of the dealer - Auto populate from Form IVA} having VAT TIN as {TIN No. -

Auto populate from Form IVA} and {Sales Tax/CST/VAT/Entry Tax/Luxury Tax/Entertainment Tax - Auto

populate the short Name of the relevant Act} R.C. No. as {R.C. No. – Auto populate from Form IVA} had filed

the application referred at serial number 1 above under sub-section (1) of section 8A of the Goa (Recovery of

Arrears of Tax, Interest, Penalty, Other Dues through Settlement) Act, 2023 (hereinafter referred to as the

“GRATIPOS Act, 2023”) for waiver of arrears under {Name of the Act – Auto populate the full Name of the

relevant Act from Form - IVA} for the assessment year/period {Assessment year/period – Auto populate from

Form IVA}.

And whereas, said application was processed and the undersigned Designated Authority had issued Form

IV A referred at serial number 2 above under sub-section (4) of Section 8A of the Goa (Recovery of Arrears of

Tax, Interest, Penalty, Other Dues Through Settlement) Act, 2023 intimating to applicant that he has failed to pay

100 % of tax demanded and has either paid less than the tax amount due or has paid 100 % tax dues but same has

been paid after 31-12-2025. Therefore, the applicant was required to make payment of this deficit tax amount plus

1034

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 24

(EXTRAORDINARY No. 2)

11TH SEPTEMBER, 2025

equal amount of late fee within 20 days from the date of receipt of the intimation for the purpose of getting waiver

of interest and penalty in accordance with the provisions of the GRATIPOS Act, 2023.

And whereas, Form IVA referred at serial number 2 above was served on the applicant

Dealer/Hotelier/Proprietor on {Date: Auto populate entered service date of Form IVA}.

And whereas, as per provisions of sub-section (4) of Section 8A of the Goa (Recovery of Arrears of Tax,

Interest, Penalty, Other Dues Through Settlement) Act, 2023, the applicant was required to pay the deficit amount

plus equal late fee amount by using e-challan on or before the date mentioned in Form IV A and submit a self-

attested photocopy of paid challan / e-receipt in the Office of the Designated authority.

And whereas,

The applicant dealer has failed to pay the total amount for settlement on or before the due date for

payment intimated in Form IVA; the due date for payment being {Date – Auto populate the due date

from Form IVA} and the actual date of payment being {Date – actual date of payment from Form VI A

OR text – “Not paid”} .

And whereas, the applicant Dealer/Hotelier/Proprietor has thus violated the provisions of sub-section (5)

of Section 8A of the Goa (Recovery of Arrears of Tax, Interest, Penalty, Other Dues Through Settlement) Act,

2023, thereby rendering him ineligible for issuance of a Certificate of Settlement in Form XA under sub-section

(2) of Section 8A of the Goa (Recovery of Arrears of Tax, Interest, Penalty, Other Dues Through Settlement) Act,

2023.

Hence, the application No. {Auto populate from Form IA} dated {Date-Auto populate from Form IA} in

Form IA filed by the applicant Dealer under sub-section (1) of Section 8A of the Goa (Recovery of Arrears of Tax,

Interest, Penalty, Other Dues Through Settlement) Act, 2023 is liable to be rejected for non-payment of 100 % tax

due amount as aforementioned.

In view of above discussion and for above recorded reasons, I pass the following

ORDER

The application No. {Auto populate from Form IA} dated {Date-Auto populate from Form IA} filed by

the applicant Dealer/Hotelier/Proprietor under sub-section (1) of Section 8A of the Goa (Recovery of Arrears of

Tax, Interest, Penalty, Other Dues Through Settlement) Act, 2023 is hereby rejected for non-payment of 100 % tax

amount on or before the dates intimated in Form IVA bearing DIN {DIN – Auto populate DIN of Form IVA}

dated {Date-Auto populate from Form IVA} issued in accordance with the provisions of sub-section (4) of

Section 8A of the GRATIPOS Act, 2023.

Consequently, the assessment, review, appeal or revision as the case may be (if applicable) under the

relevant Act which was existing as on the date of making application for waiver shall be proceeded with and

decided in accordance with the provisions of the relevant Act since this application for waiver is rejected.

The amount paid (if any) after issuance of Letter of Intimation of waiver amount in Form IV A shall be

treated as towards recovery of dues under relevant Act and the balance amount shall be recovered from applicant

in accordance with the provisions relating to recovery of outstanding dues under the relevant Act.

1035

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 24

(EXTRAORDINARY No. 2)

11TH SEPTEMBER, 2025

Application stands disposed.

Proceedings closed.

Given under the seal of this office.

({Name of the Officer – Auto populate as per login})

Dy. Commissioner of State Tax

{Ward Name - auto populate} Ward/Head Office

Designated Authority

To,

{Name of the dealer/hotelier/proprietor – Auto populate from Form IA}

{Address of the dealer – 1st Line - Auto populate from Form IA}

{Address of the dealer – 2nd Line - Auto populate from Form IA}

TIN/R.C. No.: {TIN/R.C. No - Auto populate from Form I A}

Copy for information to: -

1. The Commercial Tax Officer, {Ward address – Editable Auto populate as per the jurisdiction of RC No.},

2. Office File.

3. Guard File.

---------

FORM XIX A

SHOW CAUSE NOTICE

[See sub-section (6) of Section 8A read with Section 19(2) of the Goa (Recovery of Arrears of Tax, Interest,

Penalty, Other Dues through Settlement) Act, 2023]

DIN: {Auto generate upon Saving the document}

Date: {System Date (on saving)}

Ref: Your application No. {Auto populate from Form IA} dated {Auto populate from Form IA}

1036

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 24

(EXTRAORDINARY No. 2)

11TH SEPTEMBER, 2025

Whereas, the dealer/hotelier/proprietor, M/s {Name of the dealer/hotelier/proprietor – Auto populate

from Form IA} , {Full Address of the dealer – Editable Auto populate from Form IA } , having VAT TIN as

{TIN No. - Auto populate from Form IA} and {Sales Tax/CST/Entry Tax/Luxury Tax /Entertainment Tax –

Auto populate short Name of the relevant Act} R.C. No. as {R.C. No.- Auto populate from Form IA} have filed

the above referred online application under sub-section (1) of Section 8A of the Goa (Recovery of Arrears of Tax,

Interest, Penalty, Other Dues Through Settlement) Act, 2023 (hereinafter referred to as the “GRATIPOS Act,

2023”) for waiver of interest and penalty under {Name of the Act – Auto populate full Name of the relevant Act

from Form - IA} for the assessment year/period {Assessment year/period – Auto populate from Form IA}.

And whereas,

upon scrutiny of the above referred application, your application is liable for rejection on the following

grounds:-

And whereas,

You are therefore required to:-

Show cause in writing within 10 days from the date of receipt of this notice as to why said Form IA should

not be rejected and Order under sub-section (9) of Section 8A of GRATIPOS Act, 2023 should not be

passed holding that applicant is not eligible for waiver.

Show cause in writing within 10 days from the date of receipt of this notice as to why the intimation in

Form IVA should not be revoked under sub-section (4) of Section 8A of the GRATIPOS Act, 2023 read

with Section 21 of the General Clauses Act, 1897.

Appear in person or through a duly authorized representative before the undersigned at his chamber at the

above mentioned address, on {Date Entry Field} at {Time Entry Field}.

If you fail to furnish a reply within the stipulated date or fail to appear for personal hearing on the

appointed date and time, as aforesaid, the above referred application No. {Auto populate from Form IA} dated

{Auto populate from Form IA} shall be rejected, without any further reference to you.

Given under the seal of this office.

1037

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 24

(EXTRAORDINARY No. 2)

11TH SEPTEMBER, 2025

({Name of the Designated Authority – Auto populate as per login})

Dy. Commissioner of State Tax

{Ward Name - auto populate} Ward / Head Office

Designated Authority

To,

{Name of the dealer/hotelier/proprietor – Auto populate from Form IA}

{Address of the dealer – 1st Line - Auto populate from Form I A}

{Address of the dealer – 2nd Line - Auto populate from Form I A}

TIN/R.C. No.:{TIN/R.C. No - Auto populate from Form IA }

----------

FORM XXA

ORDER

[See sub-section(9) of Section 8A read with Section19(2) of the Goa (Recovery of Arrears of Tax, Interest,

Penalty, Other Dues through Settlement) Act, 2023]

DIN:{Auto generate up on Saving the document}

Date:{System Date (on saving)}

Ref: 1.Your application No. {Auto populate from Form IA} dated {Date- Auto populate from Form IA}

2.Form XIX A bearing DIN {DIN – Auto populate DIN of Form XIX A} dated {Date-Auto

populate from Form XIX A}

Whereas the Dealer/Hotelier/Proprietor M/s. {Name of the dealer/hotelier/proprietor– Auto populate

from Form XIX A}, {Full Address of the dealer - Auto populate from Form XIX A} having VAT TIN as {TIN

No. - Auto populate from Form XIX A} and {Sales Tax/CST/VAT/Entry Tax/Luxury Tax/Entertainment Tax -

Auto populate the short Name of the relevant Act} R.C. No. as {R.C. No. – Auto populate from Form XIX A}

had filed the application referred at serial number 1 above under sub-section (1) of Section 8A of the Goa

(Recovery of Arrears of Tax, Interest, Penalty, Other Dues through Settlement) Act, 2023 (hereinafter referred to

as the “GRATIPOS Act, 2023”) for settlement of arrears under {Name of the Act – Auto populate the full Name

of the relevant Act from Form – XIX A} for the assessment year/period {Assessment year/period – Auto populate

from Form XIX A}.

1038

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 24

(EXTRAORDINARY No. 2)

11TH SEPTEMBER, 2025

And whereas, the said applicant dealer was served with a Show Cause Notice referred at serial number 2

above directing to show cause in writing within 10 days from the date of receipt of the notice as to why his said

application should not be rejected on the ground that no question of settlement arises due to following reasons.

And whereas,

The said SCN was served on the dealer/hotelier/proprietor by {Dropdown-Registered post/Hand Delivery} and

was received by him on {Date – SCN Service Date}.

In view of above discussion and for above recorded reasons, I pass the following:

ORDER

The application no. {Auto populate from Form IA} dated {Date-Auto populate from Form IA} filed

by the applicant Dealer/Hotelier/Proprietor under sub-section(1) of Section 8A of the Goa (Recovery of

Arrears of Tax, Interest, Penalty, Other Dues through Settlement) Act, 2023 is hereby rejected.

Application stands disposed.

Proceedings closed.

Given under the seal of this office.

({Name of the Officer–Auto populate as per login})

Dy. Commissioner of State Tax

{Ward Name-auto populate} Ward /Head Office

Designated Authority

1039

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 24

(EXTRAORDINARY No. 2)

11TH SEPTEMBER, 2025

To,

{Name of the dealer/hotelier/proprietor–Auto populate from Form IA}

{Address of the dealer –1st Line-Auto populate from Form IA}

{Address of the dealer– 2nd Line-Auto populate from Form IA}

TIN/R.C. No.: {TIN/R.C. No -Auto populate from Form IA }

Copy for information to:-

The Commercial Tax Officer, {Ward address–Editable Auto populate as per the jurisdiction of RC

No.},

Office File.

3. Guard File.

**********

1040

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 24

(EXTRAORDINARY No. 2)

11TH SEPTEMBER, 2025

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