APPLICATION FOR VAT REGISTRATION [ See Rule 4 (1) ] Submit in duplicate Use separate sheet where space is not sufficient. To The Commercial Tax Officer, VAT Registering Authority, ___________________ Circle. 01. Name of the business to be registered: 02. Address of Place of business: Door No: Locality District Phone No: Email: Street Town/City Pin Code Fax No: Website/URL: 03. Occupancy Status: Owned/Rented/Leased/Rent-free/Others 04. Name & Address of the Owner Name: of business Date of Birth: (Residential Address of the Door No. Person responsible ie., Managing Locality Partner /Managing Director District for business). Phone No Email: Street Town/City Pin Code Fax No. 05. Status of business: (Mark " > " where applicable) Sole Proprietorship Partnership Private Limited Co., Public Ltd Company Govt. Enterprise Others (Specify) 06. Nature of Principal business activities: 07. Principal Commodities traded: 08. Bank Account Details: Bank Name : Branch & Code Account No. 1. 2. 3. 42 Declaration: I_____________________________S/o_________________Status_____________ of the above enterprise hereby declare that the particulars given are correct and true to the best of my knowledge and belief. I undertake to notify immediately to the registering authority in the Commercial Taxes Department of change in any of the above particulars. Date of application Signature with Stamp 43 FOR OFFICE USE ONLY 25. Date of receipt of application 26. Activity/Commodity Code 27. Exempt Indicator 28. Voluntary Registration Indicator 29. Start up 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. Taxpayer Identification Number (TIN): Processing Authority Registering Authority Name Name Designation Designation IMPORTANT: a) Copy of Proof of Identity of the sole proprietor / managing partner / managing director/ responsible person for the business like copy of passport, voter Identity card, Proof of bank account, Credit Card, Ration Card, Driving license etc., must be enclosed. b) Please fill in and enclose Form VAT 100A and 100B if found necessary. 25 to 39 : For office use only. 44
