FORM-SBY-03
Application for reimbursement of tax under the SevaBhojYojna Scheme

1. Name of the charitable/religious institution  
2. Permanent Account Number (PAN)  
3. GSTIN (if applicable)  
4. Address  
5. Unique Enrollment Number allotted by the Ministry of Culture  
6. SBY-UIN  
7. Claim period (relevant quarter) From to <Year><Month>to                      <Year><Month>
8. Amount Claimed (Rs.) Central Tax Integrated Tax (50% of the Integrated Tax paid) Total
     

9. Details of invoices:

GSTIN of the supplier Invoice No. Date Taxable Value Central Tax claimed as reimbursement Integrated Tax claimed as reimbursement (50% of the Integrated Tax paid) Total tax claimed as reimbursement (5+ 6)
1 2 3 4 5 6 7
             

10. Details of Bank Account:

SI. No. Details  
1. Bank Account Number  
2. Bank Account Type  
3. Name of the Bank  
4. Name of the Account Holder/Operator  
5. Address of Bank Branch  
6. IFSC  
7. MICR  

11. Verification

I/we                as an authorized signatory of << Name of organization >> 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.

That I/we are eligible to claim financial assistance under the Seva Bhoj Yojna and that I/we satisfy all the conditions as provided in para6 of the Guidelines on the Scheme for Financial Assistance under 'Seva Bhoj Yojna' issued by the Ministry of Culture, vide F.No. 13-1/2018-US (S&F) dated 01.08.2018.

That the amount of tax claimed as reimbursement has been paid by us/me to the supplier, on the purchase of the items specified under the Seva Bhoj Yojna Scheme of the Ministry of Culture for providing the specified activity.

That no reimbursement on this account for the claim period has been received by me/us earlier.

That in case the amount sanctioned is found to be ineligible, the same shall be paid back to the Government with interest and penalty, as provided in para 14 of the Guidelines on the Scheme for Financial Assistance under 'Seva Bhoj Yojna' issued by the Ministry of Culture, vide F.No. 13-1/2018-US (S&F) dated 01.08.2018.

Date:
Place:

Signature of Authorised Signatory:
Name:
Designation / Status

Enclosures:

1. Self-attested copies of the invoices issued by the suppliers for the purchases of the specified items mentioning the unique enrolment number allotted by Ministry of Culture and SBY-UIN;

2. A Chartered Accountant's Certificate certifying the following:

a) Quantity, price and amount of central tax, State tax/Union territory tax or integrated tax paid on the purchase of the specified items during the quarter for which the claim is filed;

b) The institution is involved in charitable/religious activities and the specified raw food items have been used for only distributing free food to the public/devotees during the claim period.

c) the reimbursement claimed in the current quarter/year is not more than the purchases in the previous corresponding quarter/year plus a maximum of 2.5%/10% for the current quarter/year, as the case may be.

d) The charitable/religious institution is using the specified items only for distributing free food to public/devotees etc during the claim period.

e) The claimant fully satisfies the conditions laid down in para 6 of the Guidelines on the Scheme for Financial Assistance under 'Seva Bhoj Yojna' issued by the Ministry of Culture, vide F.No. 13-1/2018-US (S&F) dated 01.08.2018.