CHANDIGARH ADMINISTRATION EXCISE & TAXATION DEPARTMENT Form VAT-1 [See Rule 3(2) of the Punjab VAT Rules, 2005] Application for Registration 1 Name of the applicant _______________________________________________________ 2 Trade name in which business is carried on (if different from name of applicant) 3 Type of registration VAT (Obligatory) VAT (Voluntary) TOT Tick as applicable 4 Expected Turnover in the Rs 25 lacs or above Less than Rs 25 lacs current financial year but greater than Rs 5 lacs Tick one 5 Date from which liable to tax ___ ___ / ___ ___ / ___ ___ ___ ___ DD / MM / YYYY 6 Constitution Proprietorship Private Ltd. Company Government Company of business Partnership Public Ltd. Company Government Corporation Tick one HUF Society/ Club/ Trust Central / State Government Others, please specify ________________________________________________ (Please fill details about persons having interest in business in Annexure I) 7 Nature of Manufacture Distribution Wholesale business Retail Export Import Tick all Works Contract Leasing applicable Others, please specify ________________________________________________ 8 List of principal goods _____________________________________________________ manufactured / sold 9 Permanent Account Number (PAN), if available ________________________ 10 Registration number under Central Excise Act (if applicable) ________________________ 11 Main operating Bank name: __________________ Address: _____________________________ bank account Account _____________________________________ No:___________________ 12 Address of Principal place of business in UT, Chandigarh Building Name/ Number ______________________________________________________________________ Area/ Road ______________________________________________________________________ City ______________________________________________________________________ Pin Code ______________________________________________________________________ Email Id ______________________________________________________________________ Telephone ______________________________________________________________________ Number(s) Fax Number(s) ______________________________________________________________________ 13 Number of places Outside state of business in India (Nos. only) (attach details about places of business including that of other places of business in Factories Godowns/ Warehouses Branches Shops/ Retail outlets Others (Please specify) _____________ _____________ _____________ _____________ _____________ ______________ ______________ ______________ ______________ ______________ Punjab 14 Total no. of enclosures Verification I certify that the information given in this form and its attachments (if any) is true and correct to the best of my knowledge and belief and nothing has been concealed. Signature Full name of authorized representative Designation Date Place Photo Annexure I Particulars of person(s) with interest in business 1. Name of ___________________________________________________________________ the Business 2. Full Name ___________________________________________________________________ 3. Fathers / ___________________________________________________________________ Husbands Full Name 4. Date of Birth (in case of minors) ___ ___ / ___ ___ / ___ ___ ___ ___ DD / MM / YYYY 5. Gender Male Female Tick as applicable 6. Principal Place of Business Building Name/ Number ______________________________________________________________________ Area/ Road ______________________________________________________________________ City ______________________________________________________________________ Pin Code ______________________________________________________________________ Email Id ______________________________________________________________________ Telephone ______________________________________________________________________ Number(s) Fax ______________________________________________________________________ Number(s) 7. Permanent Residential Address Building Name/ Number ______________________________________________________________________ Area/ Road ______________________________________________________________________ City ______________________________________________________________________ Pin Code ______________________________________________________________________ Email Id ______________________________________________________________________ Telephone ______________________________________________________________________ Number(s) Fax ______________________________________________________________________ Number(s) 8. Status and extent of Status _____________________ % ___________________ interest in business 9. Particulars of interest in any other business (es) within Punjab, if any. 10. Particulars of all immovable property owned by or in which the person has any interest Name of Complete Address of VRN/TRN CST Registration Nature and extent other other business No of interest in the business business Description of property Full address of the property Nature and extent of interest in the property Verification I certify that the information given in this form is true and correct to the best of my knowledge and belief and nothing has been concealed. I further declare that I shall inform the department whenever there is a change in the information provided above Signature ________________________________________________________________ Full name of the ________________________________________________________________ person Designation ________________________________________________________________ Place ________________________________________________________________ Date ________________________________________________________________ Annexure II Particulars of places of business 1. Principal place of business Building Name/ Number ______________________________________________________________________ Area/ Road ______________________________________________________________________ City ______________________________________________________________________ Pin Code ______________________________________________________________________ Email Id ______________________________________________________________________ Telephone ______________________________________________________________________ Number(s) Fax ______________________________________________________________________ Number(s) 2. State _____________________________________________ 3. Date of establishment _____________________________________________ 4. Type Godown Factory/ Industries Shop/ Retail outlets (Tick Office/ Branch Other (Please specify) One) offices 1. Additional places of business (If more than one, attach separate sheets) Building Name/ Number ______________________________________________________________________ Area/ Road ______________________________________________________________________ City ______________________________________________________________________ Pin Code ______________________________________________________________________ Email Id ______________________________________________________________________ Telephone ______________________________________________________________________ Number(s) Fax ______________________________________________________________________ Number(s) 2. State _______________________________________ 3. State local tax registration number (if _______________________________________ State is other than Punjab) 4. Date of establishment _______________________________________ 5. Type Godown Factory/ Industries Shop/ Retail outlets (Tick Office/ Branch Other (Please specify) One) offices Verification The above statement(s) are true and complete to the best of my knowledge and belief and nothing has been concealed. I further declare that I shall inform the department whenever there is a change in the information provided above Signature ________________________________________________________________ Full name of ________________________________________________________________ the person Designation ________________________________________________________________ Place ________________________________________________________________ Date ________________________________________________________________ Annexure III Particulars of authorized representative 1. Name of the __________________________________________________________ Business 2. Place of __________________________________________________________ business with address 3. Full Name of the ________________________________________________________ Authorised representative 4. Designation ________________________________________________________ 5. Permanent Residential Address Building Name/ Number ______________________________________________________________________ Area/ Road ______________________________________________________________________ City ______________________________________________________________________ Pin Code ______________________________________________________________________ Email Id ______________________________________________________________________ Telephone ______________________________________________________________________ Number(s) Fax ______________________________________________________________________ Number(s) 6. Date from which authorised to act as an ___ ___ / ___ ___ / ___ ___ ___ authorised representative ___ DD / MM / YYYY Declaration I/ We declare that the person named above is authorised to act as an authorised representative for the above referred business for which application for registration is being filed / is registered under Punjab VAT Act, 2005. His all actions in relation to this business will be binding on us. Signatories Full Signature Status Name Acceptance as an authorised representative I, accept to act as an authorised representative for the above referred business. Signature Full name of ________________________________________________________________ the person Designation ________________________________________________________________ Place ________________________________________________________________ Date ________________________________________________________________
