GOVERNMENT OF THE PEOPLE'S REPUBLIC OF BANGLADESH

NATIONAL BOARD OF REVENUE

Mushak-9.1
VALUE ADDED TAX RETURN FORM
[See Rule 47(1)]
[Please read the instructions before filling up this form]
Part - 1: TAXPAYER'S INFORMATION
(1) BIN : 000772941-0307
(2) Name of Tax Payer : ITEMS

(3) Address of Tax Payer : 54/2, Matuail Dokkhin Para , Jatrabari P.S, Dhaka 1362

(4) Type of Ownership : Proprietorship

(5) Economic Activity : Import, Exports.Indenting ,First Class contractor

Part-2: RETURN SUBMISSION DATA

(1) Tax Period : Oct-20
(2) Type of Return : (A) Main/original Return (Section 64) √
(Please select your desired option)
(B) Late Return (Section 65)

(C) Amended Return (Section 66)

(D) Full or additional or alternative Return (Section 67)

(3) Any activities in the last tax period? √

[If Selected "No" Please Fill Only the relevant Part] : Yes No

(4) Date of Submission : 15.11.2020

Part-3: SUPPLY - OUTPUT TAX

Nature of Supply Note Value (a) SD (b) VAT (c)
Direct Export 1 Sub-form
Zero Rated Goods/Service
Deemed Export 2 Sub-form
Exempted Goods/Service 3 Sub-form
Standard Rated Goods/Service 4 - - - Sub-form
Goods Based on MRP 5 Sub-form
Goods/Service Based on Specific VAT 6 Sub-form
Goods/Service Other than Standard Rate 7 - - Sub-form
Retail/Wholesale/Trade Based Supply 8 Sub-form
Total Sales Value & Total Payable Taxes 9 - - -

Part-4: PURCHASE - INPUT TAX

1. If all the products/services you supply are standard rated, fill up note 10-20.
2. All the products/services you supply are not standard rated or input tax credit not taken within stipulated time period under section 46, fill up note 21-22.
3. If the products/services you supply consist of both standard rated and non-standard rated, then fill up note 10-20 for for the raw materials that were used to produce/supply standard rated
goods/services and fill up note 21-22 for the raw materials that were used to produce/supply non-standard rated goods/services and show the value proportionately in note 10-22 as
applicable.

Nature of Purchases Note Value (a) VAT (b)

Local Purchase 10 Sub-form
Zero Rated Goods/Service
Import 11 Sub-form
Local Purchase 12 Sub-form
Exempted Goods/ Service
Import 13 Sub-form
Local Purchase 14 Sub-form
Standard Rated Goods/Service
Import 15 Sub-form
Local Purchase 16 Sub-form
Goods/Service Other than Standard Rate
Import 17 Sub-form
Goods/Service Based on Specific VAT Local Purchase 18 Sub-form
From Turnover Tax Units 19 Sub-form
Goods/Service Not Admissible for Credit (Local Purchase)
From Unregistered Entities 20 Sub-form

Goods/Service Not Admissible for Credit (Taxpayers who sell ONLY Local Purchase 21 - Sub-form
Exempted / Specific VAT and Goods/Service Other than Standard
Rate/Credits not taken within stipulated time) Import 22 1,559,852 - Sub-form
Total Input Tax Credit 23 1,559,852 -

Page 1 of 11
 Part-5: INCREASING ADJUSTMENTS (VAT)
Adjustment Details Note VAT Amount
Due to VAT Deducted at Source by the Supply receiver 24 Sub-form
Payment Not Made Through Banking Channel 25
Issuance of Debit Note 26
Any Other Adjustments (please specify below) 27
Total Increasing Adjustment 28 -

Part-6: DECREASING ADJUSTMENTS (VAT)

Adjustment Details Note VAT Amount
Due to VAT Deducted at Source from the supplies delivered 29 7,064,838.00 Sub-form
Advance Tax Paid at Import Stage 30 Sub-form
Issuance of Credit Note 31
Any Other Adjustments (please specify below)
32

Total Decreasing Adjustment 33 7,064,838

Part-7: NET TAX CALCULATION

Items Note Amount(Tax)
Net Payable VAT for the Tax Period (Section-45) (9c-23b+28-33) 34 (7,064,838.00)
Net Payable VAT for the Tax Period after Adjusted with Closing Balance and balance of form 18.6 [(34-(52+56)] 35 (7,600,897.00)
Net Payable Supplementary Duty for the Tax Period (Before adjustment with Closing Balance) [9b+38-(39+40)] 36
Net Payable Supplementary Duty for the Tax Period after Adjusted with Closing Balance and balance of form 18.6 [36-
(53+57)] 37
Supplementary Duty Against Issuance of Debit Note 38
Supplementary Duty Against Issuance of Credit Note 39
Supplementary Duty Paid on Inputs Against Exports 40
Interest on Overdue VAT( Based on note 35) 41
Interest on Overdue SD ( Based on note 37) 42
Fine/Penalty for Non-submission of Return 43
Other Fine/Penalty/Interest 44
Payable Excise Duty 45
Payable Development Surcharge 46
Payable ICT Development Surcharge 47
Payable Health Care Surcharge 48
Payable Environmental Protection Surcharge 49
Net Payable VAT for treasury deposit (35+41+43+44) 50
Net Payable SD for treasury deposit (37+42) 51
Closing Balance of Last Tax Period (VAT) 52 536,059
Closing Balance of Last Tax Period (SD) 53

Part-8: ADJUSTMENT FOR OLD ACCOUNT CURRENT BALANCE

Item Note Amount(Tax)
Remaining Balance (VAT) from Mushak–18.6, [ Rule 118(5)] 54 Opening Balanc
Remaining Balance (SD) from Mushak–18.6, [ Rule 118(5)] 55 - N/A fo
Decreasing Adjustment for Note 54 (up to 10% of Note 34) 56 -
Decreasing Adjustment for Note 55 (up to 10% of Note 36) 57 -

Part-9: ACCOUNTS CODE WISE PAYMENT SCHEDULE (TREASURY DEPOSIT)

Item Note Economic Code Amount
VAT Deposit for the Current Tax Period 58 1 / 1133 /0030/ 0311 - Sub-form
SD Deposit for the Current Tax Period 59 1 / 1133 /………... / 0721 - Sub-form
Excise Duty 60 1 / 1133 /……….../ 0601 - Sub-form
Development Surcharge 61 1 / 1103 / 0000 / 2225 - Sub-form
ICT Development Surcharge 62 1 / 1103 / 0000 / 2214 - Sub-form
Health Care Surcharge 63 1 / 1103 / 0000 / 2212 - Sub-form
Environmental Protection Surcharge 64 1 / 1103 / 0000 / 2213 - Sub-form

Page 2 of 11
 Part-10: CLOSING BALANCE
Item Note Amount
Closing Balance (VAT) [58-(50+67) + The refund amount not approved] 65 (7,600,897.00)
Closing Balance (SD) [59-(51+68) + The refund amount not approved] 66 -

Part-11: REFUND
I am interested to get refund of my Closing Balance Items Note Yes No
Requested Amount for Refund (VAT) 67
Requested Amount for Refund (SD) 68

Part-12: DECLARATION
I hereby declare that all information provided in this Return Form are complete, true & accurate. In case of any untrue/incomplete statement, I may be subjected to
penal action under The Value Added Tax and Supplementary Duty Act, 2012 or any other applicable Act prevailing at present.

Name : Md .Oliullah Mamun

Designation : Proprietor
Mobile Number : 01832595392
National ID/Passport Number : 5098410623
Email : [email protected]
Signature
[ Not required for electronic :
submission]

Page 3 of 11
Sub Form (For Note No-1,2,3,4,5,6,7,10,11,12,13,14,15,16,17,19,20,21 and 22 )
SL No Commercial description of Good/Service Goods/Service Code Goods/Service Name Value (a) SD(b) VAT(c) Notes
Other Optical Microscopes, Nes 9011.80.00 Other Optical Microscopes, Nes 1,348,837 101,163 7
Mortuary with six bodies cold storage 8418.29.00 Mortuary with six bodies cold storage 11,906,977 893,023 7
Portable Sucker Machine 9018.90.10 Biology Boxes 837,209 62,791 7
Hospital Beds 9402.90.10 Hospital Beds 1,302,325 97,675 7
Total 15,395,348 1,154,652 7

Medical, surgical or veterinary furniture & parts Medical, surgical or veterinary furniture
thereof (exc hospital bed 9402.90.90 & parts thereof (exc hospital bed 16,55,659.91 2,48,348.99 22
Ozone Therapy,Oxygen Therapy,Aerosol Ozone Therapy,Oxygen Therapy,Aerosol
Therapy,Respiration Apparatus Nes. 9019.20.90 Therapy,Respiration Apparatus Nes. 2,90,545.16 43,582 22
Medical,Surgical Or Veterinary Furniture & Parts Medical,Surgical Or Veterinary Furniture
Therof (Exc Hosopital Bed 9402.90.90 & Parts Therof (Exc Hosopital Bed 11,79,200.56 1,76,880.08 22
Other Optical Microscopes, Nes 9011.80.00 Other Optical Microscopes, Nes 900,951 861 22
Household refrigerators, nes 8418.29.00 Household refrigerators, nes 5,181,567 777,235 22
Biology Boxes 9018.90.10 Biology Boxes 590,680 88,602 22
Hospital Beds 9402.90.10 Hospital Beds 99,020 14,853 22
Total 6,772,218 925,133 22
Sub Form (For Note No-1,2,3,4,5,6,7,10,11,12,13,14,15,16,17,19,20,21 and 22 )
SL No Commercial description of Good/Service Goods/Service Code Goods/Service Name Value (a) SD(b) VAT(c) Notes

Total - - 7

Other Electro-Diagnostic Apparatus Nes 90181990 Other Electro-Diagnostic Apparatus Nes 1,559,852 22

Total 1,559,852 - 22
Sub Form (For Note No-1,2,3,4,5,6,7,10,11,12,13,14,15,16,17,19,20,21 and 22 )
SL No Commercial description of Good/Service Goods/Service Code Goods/Service Name Value (a) SD(b) VAT(c) Notes
ENT Treatment Unit with complete system 90181990 ENT Treatment Unit with complete syste 4,300,000 300,000 7

Total 4,300,000 300,000

ENT Treatment Unit with complete system 90181990 ENT Treatment Unit with complete syste 1,438,055 7,848 17
Syringe pump Syringe pump 527,540 81,390 17
Infulsion pump Infulsion pump 291,124 43,866 17
Defibrillator/Monitor(Eng. Version)with stadard accessories Defibrillator 580,607 95,735 17
Total 2,837,325 228,839 16
Syringe pump Syringe pump 900,000
Total 900,000
Sub Form (For Note No- 6 and 18 )
Actual
SL No Good/Service Commercial description Goods/Service Code Goods/Service Name Unit of Measures (a) Quantity (b) Sales/Purachase SD(d) VAT(e) Notes
Value(c)
Sub Form (For Note No- 8 )
SL No Category Good/Service Commercial description Goods/Service Code Goods/Service Name Value (a) SD(b) VAT(c) Notes
1 Commercial Importer/Other Traders
2 Petroleum Products
3 Super-shop
4 Medicine related Products
Sub-form (For Note-24 )
VAT Deduction VAT Tax Tax
Deduction Tax deposit serial
SL No Supplier's BIN Supplier's Name Supplier's Address Value Deducted VAT Invoice No/Challan/Bill No- Invoice/Challan/Bill at source, deposit deposit Notes
etc.) Date Certificate at source, Account number of Book date
Certificate transfer
No Code
date
Sub-form (For Note-29 )
VAT Deduction VAT Tax Tax
Deduction Tax deposit serial
SL No Buyer's BIN Buyer's Name Buyer's Address Value Deducted VAT Invoice No/Challan/Bill No- Invoice/Challan/Bill at source, deposit deposit Notes
etc.) Date Certificate at source, Account number of Book date
Certificate transfer
No Code
date
Sub-form (For Note-30 )
SL No Bill of Entry Number Date Customs House/Customs Station Advance Tax amount Notes
1 C 1071290 9/8/2020 Customs House, Chittagong 82,783
2 C 653763 24/09/2020 Dhaka Customs House 14,527
3 C 619842 14/09/2020 Dhaka Customs House 58,960
4 C 607748 9/9/2020 Dhaka Customs House 45,048
5 C 1278331 16/9/2020 Customs House, Chittagong 259,078
6 C 610132 10/9/2020 Dhaka Customs House 29,534
7 C 1226849 6/9/2020 Customs House, Chittagong 49,903
8 C 290309 5/5/2020 Dhaka Customs House 60,392
9 C 387420 21/6/2020 Dhaka Customs House 41,752
10 C 392458 23/6/2020 Dhaka Customs House 38,216
11 C 393144 23/6/2020 Dhaka Customs House 31,912
12 C 435699 9/7/2020 Dhaka Customs House 6,824
Total 718,929