ap vat registration forms
DESCRIPTION
To get VAT, TOT and CST License under AP VAT ACT 2005.TRANSCRIPT
FORM VAT 250
APPLICATION OPTING FOR PAYMENT OF TAXBY WAY OF COMPOSITION
[ see Rules 17(2)(b), 17(3)(c), 17(4)(b) & 19(5) ]
Date Month Year01 Tax Officer Address
01 11 07Commercial Tax OfficerMalakpet Circle
Hyderabad02 TIN
03 Name
Address
I / we carrying on business as a Works contactor / as a hotelier do hereby apply to pay sales tax by wayof composition.
* I) At the rare of 4% on the total value of the contract executed for the Government or local Authority subject to such conditions as may be prescribed.
* II) At the rate of 4% on 50% of the total consideration received or receivable for the contract other than state Government and local authorities subject to such conditions as may be prescribed.
* III) At the rate of 4% on 25% of the consideration received or receivable or the market value fixed for the purpose of stamp duty whichever is higher, for the contact of constructing and selling of residential apartments, houses building or commercial complexes subject to such conditions as may be prescribed.
* Iv) At the rate of 12.5% on 60% of the total consideration charged for food and drink to such conditions as may be prescribed.
The details of contracts for which composition is opted for are given below:
SL Name & Address of the Nature of Contract Date of Full value of theNO. Contractee Contract Contract
01
(* Strike off whichever is not applicable ) Signature of the Dealer,Stamp and seal
FORM VAT 250
APPLICATION OPTING FOR PAYMENT OF TAXBY WAY OF COMPOSITION
[ see Rules 17(2)(b), 17(3)(c), 17(4)(b) & 19(5) ]
Date Month Year01 Tax Officer Address
01 11 07Commercial Tax OfficerMalakpet Circle
Hyderabad02 TIN 2 8 4 0 0 1 4 5 4 8 7
03 Name D.Nagappa ( contractor)
Address 16-2-147/F/5, Malakpet, Hyderabad-36
I / we carrying on business as a Works contactor / as a hotelier do hereby apply to pay sales tax by wayof composition.
* I) At the rare of 4% on the total value of the contract executed for the Government or local Authority subject to such conditions as may be prescribed.
* II) At the rate of 4% on 50% of the total consideration received or receivable for the contract other than state Government and local authorities subject to such conditions as may be prescribed.
* III) At the rate of 4% on 25% of the consideration received or receivable or the market value fixed for the purpose of stamp duty whichever is higher, for the contact of constructing and selling of residential apartments, houses building or commercial complexes subject to such conditions as may be prescribed.
* Iv) At the rate of 12.5% on 60% of the total consideration charged for food and drink to such conditions as may be prescribed.
The details of contracts for which composition is opted for are given below:
SL Name & Address of the Nature of Contract Date of Full value of theNO. Contractee Contract Contract
01 Superintending Engineer(II) Civil Contract 10/29/2007 Rs. 10,70,000/-Greater Hyderabad, MCH6th Floor, C.C Complex,Tank Bund Road,Hyderabad-63
Work order No224/ SE-II / GHMC / T5 /2007-2008/2576
(* Strike off whichever is not applicable ) Signature of the Dealer,Stamp and seal
FORM VAT 250
APPLICATION OPTING FOR PAYMENT OF TAXBY WAY OF COMPOSITION
[ see Rules 17(2)(b), 17(3)(c), 17(4)(b) & 19(5) ]
Date Month Year01 Tax Officer Address
Commercial Tax Officer
02 TIN
03 Name
Address
I / we carrying on business as a Works contactor / as a hotelier do hereby apply to pay sales tax by wayof composition.
* I) At the rare of 4% on the total value of the contract executed for the Government or local Authority subject to such conditions as may be prescribed.
* II) At the rate of 4% on 50% of the total consideration received or receivable for the contract other than state Government and local authorities subject to such conditions as may be prescribed.
* III) At the rate of 4% on 25% of the consideration received or receivable or the market value fixed for the purpose of stamp duty whichever is higher, for the contact of constructing and selling of residential apartments, houses building or commercial complexes subject to such conditions as may be prescribed.
* Iv) At the rate of 12.5% on 60% of the total consideration charged for food and drink to such conditions as may be prescribed.
The details of contracts for which composition is opted for are given below:
SL Name & Address of the Nature of Contract Date of Full value of theNO. Contractee Contract Contract
(* Strike off whichever is not applicable ) Signature of the Dealer,
Stamp and seal
FORM VAT 213
APPLICATION FOR UNDER / OVER DECLARATION OF VALUE ADDED TAX[ See Rule 23(6) (a) ]
Date Month Year01 Tax Office Address:-
10 09 07
02 TIN
03 Name
Address:-
Examination of my records has shown that the correct amount of Value Added Tax in the return for tax period
01-05-2007 was * under declared / over- declared. Please find a true and correct summary of my monthly
Return as below. The errors were caused by
Tax Input Output Input tax Output tax Tax under / Total Amount period Tax Tax found to found to over-declared payable /
declared declared be correct be correct Creditable
5/1/2007 89602 93781 90307 94486 0 0 to
5/31/2007
I ( Name) E. Ramesh
being ( Title ) Proprietor of the above business
do hereby declare that the information given on this form is true and correct.
Signature / Stamp Date of Declaration 9/10/2007
PLEASE DO NOT ADJUST ANY FURTHER RETURN FOR THE TAX SHOWN ON THIS FORM.
Complete in Duplicate
* Strike off which ever is not applicable Signature & Status
FORM 560
NOMINATION OF RESPONSIBLE PERSON[ see Rule 63(1) & (3) ]
DECLARATION NOTIFYING PERSONS AUTHORISED TO SING ANY RETURN /DOCUMENT / STATEMENTS AND TO RECEIVE NOTICES, ORDERS, ETC.,
UNDER THE ANDHRA PRADESH VALUE ADDED TAX ACT 2005
TO
Name : Date Month Year
Address : 25 01 2008
TIN / GRN
I / we Mr. Sunkara Chandra Sekhar, Director of TYCHE MARKETING PVT LTD
being proprietor / Managing partner / Managing Director etc., do hereby authorise the
following person(s) to sign any return / documents / statements / and to receive notices
orders etc., under the Andhra Pradesh Value Added Tax Act, 2005.
Sl. Name of the person Status and relationship Specimen signatureno. of the person to the dealer of the person
named in col.(2)
{1) { 2} {3} {4}
1
Signature of the Dealer(s) / Athorised signatory
I / we accept the above responsibility.
Signature of the person(s) authorised
FORM VAT 100APPLICATION FOR VAT REGISTRATION
[ See Rule 4(1) ]
Submit in duplicateUse separate sheet where space is not sufficient
ToThe Commercial Tax Officer,VAT Registering Authority,LORDBAZAAR Circle.
01. Name of the Businessto be registered :
02. Address of Place of business:
Door No. Street
Locality, District
Town/ City Pin Code
Phone No. Fax No
E-Mail Website URL
03. Occupancy Status : Owned Rented X Leased Rent-free Others
04. Name & Address of the Owner of business :( Residential Address of the person responsible ie., Managing partner /
Managing Director for business ).
Name
Date of Birth
Door No., Street
Locality District
Town / City Pin Code
Phone No. Fax No
05.
Sole Proprietorship Partnership Private Limitede Company X
Public Limited Company Govt, Enterpise Others ( Specify )
06. Nature of Prinicipal business activties TRADING
07 Prinicipal Commoditied traded Napkins
Baby Diapers
08. Bank Account Details
Bank Name Branch & Code Account No
1
2
3
09 Income Tax Permanent Account Number : (PAN )
Status of business : ( Mark "√ " where applicable )
Affix a passport size photo of sole Propreitor.In case of Partnership firms/Companies/others Affix photos of responsible persons on VAT 100B.
10. Address of additional places of business/ Branches/
NO
11 Particulars of owner / partners / Directors etc., Yes
Use Form VAT 100B
12 Language in which books are written English
13 Are your accounts computerized Yes NO x
Date Month Year
14 Date of First taxable sale
15 Turnovers of taxable sales of goods including
zero rate in
a) The last 3 months Rs --b) The last 12 months Rs
16 Anticipated turnovers of taxable sales of goods
including zero rate in
a) The next 3 months Rs
b) The next 12 months Rs
17 Anticipated Turnover of exempted sales of
goods and transactions in the next 12 months --
18 Are you applying for voluntary registration Yes x NO
19 Are you applying for registration as start
up Business Yes NO x
20 Indicate your GRN Number, if any
Have you appliced for CST Registration Yes x NO
21 Registration Number ( if any under No
Profession Taxc Act )
22 Do you expect your input tax to regulary Yes NO xexceed your outpu tax ?
if yes Why?
23 Are you applying for registration in response to Yes NO xa notice by the Tax Officer ?
If yes, indicate the Notice number --
24 Any other relevant information like are you --availing Tax incentives? If so write details
D E C L A R A T I O N
S/o
Status Directorthe above enterprise hereby declare that the particulars given are correct and true to the best of my Knowledge and belief.I under take to notify immediately to the registering authority in the Commercial Taxes Department of change in ay of the above particulars
Date of application Signature with stamp
Godowns ( Including those outside A.P).Use Form VAT 100A
FOR OFFICE USE ONLY
25 Date of receipt of application
26 Activity / Commodity Code
27 Exempt Indicator
28 Voluntary Registration Indicator
29 Startup Business Indicator
30 CST Indicator
31 Refund Indicator
32 Works Contract Indicator
33 Suo motu Registration Indicator
34 Special Rates- Schedule-VI goods Indicator
35 Tax Incentives Indicator
36 Date of issue of Registration Certificate
37 Effective date of Registration
38 Date of refusal of Registration
39 Tax payer Identification Number (TIN)
PROCESSING AUTHORITY REGISTERING AUTHORITY
NAME NAME
DESIGNATION DESIGNATION
FORM VAT 100ADETAILS OF ADDITIONAL PLACES OF
BUSINESS / BRANCHES / GODOWNS IN ANDHRA PRADESH
NAME OF THE BUSINESS :
01 Address
Pin Code NO Telephone No
Signature Date
02 Address
Pin Code NO Telephone No
Signature Date
03 Address
Pin Code NO Telephone No
Signature Date
04 Address
Pin Code NO Telephone No
Signature Date
05 Address
Pin Code NO Telephone No
Signature Date
ADDRESSESS OF BRANCHES / GODOWNS LOCATED
OUTSIDE ANDHRA PRADESH
01 StateAddress
PIN Code No Telephone No
R.C. Number under state Act:R.C. Number under C.S.T Act:
Signature Date
02 StateAddress
PIN Code No Telephone No
R.C. Number under state Act:R.C. Number under C.S.T Act:
Signature Date
03 StateAddress
PIN Code No Telephone No
R.C. Number under state Act:R.C. Number under C.S.T Act:
Signature Date
04 StateAddress
PIN Code No Telephone No
R.C. Number under state Act:R.C. Number under C.S.T Act:
Signature Date
FORM VAT 100BPARTICULARS OF PARTNERS / DIRECTORS / PERSONS
RESPONSIBLE (AUTHORISED) FOR THE BUSINESS
NAME OF THE BUSINESS :
1. Fill in the details for each Partner / Director / Responsible Person Separately in the
2. Strike off partners / Director / Responsible Persons whichever is not applicablePARTNERS / DIRECTORS / PERSONS RESPONSIBLE DETAILS
1 Full Name
2 Father's / Husband's Name
3 Date of Birth
4 Extent of interest in business ( Partnership firm) /
Official Designation and date of joining in the present
capacity ( in case of Directors in Limited Companies) /
status & function of person Responsible ( Authorised )
of the business.
05 Other business interests in the state ( Please specify )
06 Other business interests outside the state( Please specify)
07 Present Residential Address:
Telephone
08 Permanent Address
Telephone
09 Income Tax Permanent Account Number (PAN)
DateSignature & Status
PARTNERS / DIRECTORS / PERSONS RESPONSIBLE DETAILS
1 Full Name2 Father's / Husband's Name3 Date of Birth4 Extent of interest in business ( Partnership firm) /
Official Designation and date of joining in the presentcapacity ( in case of Directors in Limited Companies) /status & function of person Responsible ( Authorised ) of the business.
05 Other business interests in the state ( Please specify )06 Other business interests outside the state( Please specify)07 Present Residential Address:
TelephoneE-Mail
08 Permanent AddressTelephone
09 Income Tax Permanent Account Number (PAN)
DateSignature & Status
boxes provided for. Please Use BLOCK LETTERS and write clearly.
Affix a passport size photo
of Partner /Director / Person
Responsible
Affix a passport size photo of
Partner /Director / Person
Responsible
PARTNERS / DIRECTORS / PERSONS RESPONSIBLE DETAILS
1 Full Name2 Father's / Husband's Name3 Date of Birth4 Extent of interest in business ( Partnership firm) /
Official Designation and date of joining in the presentcapacity ( in case of Directors in Limited Companies) /status & function of person Responsible ( Authorised ) of the business.
05 Other business interests in the state ( Please specify )06 Other business interests outside the state( Please specify)07 Present Residential Address:
TelephoneE-Mail
08 Permanent AddressTelephone
09 Income Tax Permanent Account Number (PAN)
DateSignature & Status
Affix a passport size photo of
Partner /Director / Person
Responsible
FORM - AApplication for Registration as a Dealer Under Section 7(1) / 7(2)
of the Central Sales Tax Act, 1956( See Rule 3)
To
The Assistant / Deputy Commercial Tax Officer
DIV Cir Unit
S/o
( Name of applicant ) ( Name of Father )
on behalf of the dealer carrying on the business know as
( Name of buisness ) ** ( Style / Nature of business )
within the state of ANDHRA PRADESH hereby apply for a certificate of registration under section 7(1) / 7(2) of theCentral Sales Tax Act, 1956 and give following particulars for this purpose.
1 Name of the person deemed to be the manager in relation to the business of the dealer in the said state
2 Status of the applicant 1. Manager 2. Partner 3. Proprietor
( Tick whichever is applicable ) 4. Director 5. Officer-in-charge of the Government business
3 Name and full postal address of the principal place of business in the said state:
Name
Address
Building Name Building Number
Ward Name Ward Number
Street / Road
Village / Town
District STATE
Pincode
** Nature of business may be--1 Partnership 4 Govt Company 7 works contract 10 Hotels2 public Ltd 5 Society 8 Hindu undivided family11 Club3 Private Ltd 6 Association 9 Trust
2
4 Name(s) and address(es) of the other places of business in the said state. ( if the space in this column is found to be
insufficient, additional sheets, may be used and duly signed.)
Name
Address
Building Name Building Number
Ward Name Ward Number
Street / Road
Village / Town
District STATE
Pincode
Page number(s) of additional sheet(s) used:
5 Complete list of godowns in which the goods relating to the business are stored and address of every such godown
( Attach additional sheet if required ).
Name
Address
Building Name Building Number
Ward Name Ward Number
Street / Road
Village / Town
District STATE
Pincode
Page number(s) of additional sheet(s) used:
6 Name(s) and address(es) of the other places of business in each of the other states( Attach additional sheets, if required).
Name
Address
Building Name Building Number
Ward Name Ward Number
Street / Road
Village / Town
District STATE
Pincode
Page number(s) of additional sheet(s) used:
3
7 The business is
Wholly
Mainly
Partly
Specify whether business is wholly agriculture, mining, manufacturing, leasing, wholesale distribution, retail
distribution, contracting or catering etc., or any combination of two or more of them.
8 Particulars relating to registration, licence, permission etc., issued under any law for the time being in force, of the dealer
DIV CIR UNIT NUMBER
APGST
9 Name and address of the Chamber of Commerce, Trade Association or Commercial body of which the dealer is a member
Name:
Address:
10 The Language in which the accounts are English
Kept and maintained
11 Name(s) and address(es) of the proprietor, partners, members, all persons having any interest in the business
( Additional sheets with the following columns shall be used, for each partner / Director if necessary ).
a) Serial Number
b) Name in full of each person
c) Name of father of each person
d) Age of each person
e) Extent of interest of each person
in the business
f) Present address of each person
g) Permanent address of each person
h) Signature of each person
i) Name, address and signature of witness attesting signature and identifying the proprietor / partners at SL.NO. 11(h)
Partners
SL.NO Name Signature
1 2 3
1
2
4
Attestation by witness ( Registrered dealer )
Name Address R.C Number Signature
1 2 3 4
DD MM YY
12 Date of Commencement of business
DD MM YY
13 The first sale in the course of inter-state trade was effected on
From To
14 The accounting year followed by the dealer for the purposes
of Income Tax Act
( State month or festival )
15 We make up our accounts of sales at the end of ( Tick 1. Everymonth 2. quarter
whichever is applicabe). 3. Half year 4. Year
16 Details of goods ordinarily purchased by the dealer in interstate trade: ( Attach additional sheets if required )
a) For resale
Commodity description Code Commodity description Code
1 3
2 4
Page number(s) of additional sheet(s) used
b) Use in Manufacture of goods or processing of goods for sale
Commodity description Code Commodity description Code
1 3
2 4
Page number(s) of additional sheet(s) used
5
c) Use in the mining /use in the generation or distribution of electricity / use in packing of goods for
sale / resale ( Tick whichever is applicable ).
Commodity description Code Commodity description Code
1 3
2 4
Page number(s) of additional sheet(s) used
17 Name of goods manufactured by the dealer-- (Attach additional sheets if required )
Commodity description Code Commodity description Code
1 3
2 4
Page number(s) of additional sheet(s) used
D E C L A R A T I O N
I, son / daughter/
wife of declare that to
the best of my. Knowledge and belief, the information in this application given above is true and correct.
Place
Date HYDERABAD Name, address and signature of the person signing with
the status and relationship to the dealer.
( Here state whether Manager, partner, proprietor, Director,
Officer-in-charge of the Government business)
6( FOR OFFICIAL USE BY THE REGISTERING AUTHORITY)
1 Date of receipt of application
2 Nature of order passed by the Registering
Authority in the application
DIV CIR UNIT NUMBER
3 Registration Certificate number and date
of issue ( APGST)
Date
DD MM YY
DIV CIR UNIT NUMBER
4 Registration certificate number
and date of issue (CST)
Date
DD MM YY
5 No. of branches
6 No. of godowns
7 No. of partners
8 No.of commodities
9 Old R.C No APGST
10 Old R.C No CST
SINGATURE OF THE REGISTERING AUTHORITY
Note: 1 On every additional sheet of paper used, indicate the Registration Certificate number with division,
circle and unit number.Also indicate the serial number of the information to which it pertains.
2 Write the page number of each, additional sheet attached to this form starting from page number 7
3. Total number of pages enclosed
11 Name(s) and address(es) of the proprietor, partners, members, all persons having any interest in the business
( Additional sheets with the following columns shall be used, for each partner / Director if necessary ).
a) Serial Number
b) Name in full of each person
c) Name of father of each person
d) Age of each person
e) Extent of interest of each person
in the business
f) Present address of each person
g) Permanent address of each person
h) Signature of each person
12 Name(s) and address(es) of the proprietor, partners, members, all persons having any interest in the business
( Additional sheets with the following columns shall be used, for each partner / Director if necessary ).
a) Serial Number
b) Name in full of each person
c) Name of father of each person
d) Age of each person
e) Extent of interest of each person
in the business
f) Present address of each person
g) Permanent address of each person
h) Signature of each person
FORM 565
FORM OF AUTHORISATION[ See Rule 65(7) ]
AUTHORISATION TO BE FILED BY A PERSON APPEARING BEFORE ANY
AUTHORITY BEHALF OF A DEALER UNDER SECTION 66 OF THE
ANDHRA PRADESH VALUE ADDED TAX ACT 2005
To
NameDate Month Year
Address2008
TIN / GRN
I / we hereby
appoint sri who is my relative /a
person regularly employed by me / the said*
/ a legal practitioner/a Chartered Accountant/a Sales Tax Practitioner to attend on my behalf / behalf of
the said* / before
( State the Tax Authority ) the proceedings ( describe the proceedings)
before the said ( state the Tax Authority )
and to produce accounts and documents / statements and to receive on my behalf / behalf of the said**
any notice or documents/ statements issued
in connection with the said proceedings . Sri
is here by authorised to act on my behalf / behalf of the said*
in the said proceedings.
I agree / the said* agrees to ratify all acts done
by the said sri in pursuance of this authorisation.
Signature(s) of the Authorizing person(s)
I/ we accept the above responsibility
*/** Delete as appropriateSignature(s) of Authorised person(s)
FORM TOT 001APPLICATION FOR TOT REGISTRATION
[ See Rule 4(2) ]
Submit in duplicateUse separate sheet where space is not sufficient
ToThe Commercial Tax Officer,VAT Registering Authority,
Circle.
01. Name of the dealer :APGST NO. if any :
02. Address of Place of business:
Door No. Street
Locality, District
Town/ City Pin Code
Phone No. Fax No
E-Mail Website URL
03. Occupancy Status : Owned Rented X Leased Rent-free Others
04.
Sole Proprietorship X Partnership Private Limitede Company
Public Limited Company Govt, Enterpise Others ( Specify )
05. Name & Address of the Owner of business :( Residential Address of the person responsible ie., Managing partner /
Managing Director for business ).
Name
Date of Birth
Door No., Street
Locality District
Town / City Pin Code
Phone No. Fax No
06. Nature of Prinicipal business activties
07 Prinicipal Commoditied traded
08. Bank Account Details
Bank Name Branch & Code Account No
1
2
3
09 Income Tax Permanent Account Number : (PAN )
Status of business : ( Mark "√ " where applicable )
Affix a passport size photo of sole Propreitor.In case of Partnership firms/Companies/others Affix photos of responsible persons on 001B.
10. Address of additional places of business/ Branches/
NIL
11 Particulars of owner / partners / Directors etc., ENCLOSED
Use Form 001B
12 Taxable Turnover of your business for the last 12 0consecutive months
13 Estimated taxable turnover of your business for next
12 consecutive months
14 Date on which taxable turnover for 12 consective months N A
exceeded Rs. 5 lakhs
15 Registration Number
( if any under Professional Tax Act )
D E C L A R A T I O N
W/o
Statusthe above enterprise hereby declare that the particulars given are correct and true to the best of my Knowledge and belief.I under take to notify immediately to the registering authority in the Commercial Taxes Department of change in ay of the above particulars
Date of application Signature with stamp
FOR OFFICE USE ONLY
16 Date of receipt of application
17 Effective date of registration
18 Date of certificate by Registering Authority
19 Date of refusal of registration by Registering Authority
20 GENERAL REGISTRATION NUMBER
Godowns ( Including those outside A.P).Use Form 001A
FORM TOT 001AADDRESSES OF ADDITIONAL PLACES OF
BUSINESS / BRANCHES / GODOWNS IN ANDHRA PRADESH
NAME OF THE BUSINESS :
1 Fill in the addresses of Additional Places of Business/ Branches/Godowns in the spaces provided for.
2 Strike off additional Places of Business/Branches/Godowns whichever is not applicable
ADDITIONAL PLACE OF BUSINESS/ BRANCH/GODOWN
01 Address
Pin Code NO Telephone No
Signature Date
ADDITIONAL PLACE OF BUSINESS/ BRANCH/GODOWN
02 Address
Pin Code NO Telephone No
Signature Date
ADDITIONAL PLACE OF BUSINESS/ BRANCH/GODOWN
03 Address
Pin Code NO Telephone No
Signature Date
ADDITIONAL PLACE OF BUSINESS/ BRANCH/GODOWN
04 Address
Pin Code NO Telephone No
Signature Date
ADDITIONAL PLACE OF BUSINESS/ BRANCH/GODOWN
05 Address
Pin Code NO Telephone No
Signature Date
ADDITIONAL PLACE OF BUSINESS/ BRANCH/GODOWN
06 Address
Pin Code NO Telephone No
Signature Date
ADDITIONAL PLACE OF BUSINESS/ BRANCH/GODOWN
06 Address
Pin Code NO Telephone No
Signature Date
ADDITIONAL PLACE OF BUSINESS/ BRANCH/GODOWN
07 Address
Pin Code NO Telephone No
Signature Date
FORM TOT 001B PARTICULARS OF PARTNERS / DIRECTORS / PERSONS
RESPONSIBLE (AUTHORISED) FOR THE BUSINESS
NAME OF THE BUSINESS :
1. Fill in the details for each Partner / Director / Responsible Person Separately in the
2. Strike off partners / Director / Responsible Persons whichever is not applicable
PARTNERS / DIRECTORS / PERSONS RESPONSIBLE DETAILS
1 Full Name
2 Father's / Husband's Name
3 Date of Birth
4 Extent of interest in business ( Partnership firm) /
Official Designation and date of joining in the present
capacity ( in case of Directors in Limited Companies) /
status & function of person Responsible ( Authorised )
of the business.
05 Other business interests in the state ( Please specify )
06 Other business interests outside the state( Please specify)
07 Present Residential Address:
Telephone
08 Permanent Address
Telephone
09 Income Tax Permanent Account Number (PAN)
DateSignature & Status
PARTNERS / DIRECTORS / PERSONS RESPONSIBLE DETAILS
1 Full Name
2 Father's / Husband's Name
3 Date of Birth
4 Extent of interest in business ( Partnership firm) /
Official Designation and date of joining in the present
capacity ( in case of Directors in Limited Companies) /
status & function of person Responsible ( Authorised )
of the business.
05 Other business interests in the state ( Please specify )
06 Other business interests outside the state( Please specify)
07 Present Residential Address:
Telephone
08 Permanent Address
Telephone
09 Income Tax Permanent Account Number (PAN)
Date
boxes provided for. Please Use BLOCK LETTERS and write clearly.
Affix a passport size photo of
Partner /Director / Person
Responsible
Affix a passport size photo of Partner /
Director / PersonResponsible
Signature & Status