Form VAT - I [See rule 14(1)] Application for the grant of Certificate of Registration under section 18 of the Goa Value Added Tax Act, 2005 (Act 9 of 2005). To The Assessing Authority, .........Ward. I/We .......................Proprietor/Partner(s)Manager/ Director/Karta of HUF/Principal Officer managing the business/Society, of the business hereby apply on behalf of the said business for grant of a Certificate of Registration under the Goa Value Added Tax Act, 2005 and attach herewith a Treasury/Bank receipt dated ........ for Rs. .........being the registration fee paid. (1) Name and Style of business........................... (2) Principal place of business:......................... Address.................................. ........................................... Phone........... (3) The business has .....(number) additional places of business and has..... (number) separate warehouses at the addresses enumerated below: a) Additional places of business(indicate full address): __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ b) Warehouses (indicate full address) .................................... ................................. (4) The dealer has business in under mentioned States(give full details with registration number) Name of the State Address Registration Number/TIN ........ ................... ........... (5) Permanent Account Number of the business under Income Tax Act (PAN)....... (6) Registration Number under the Goa Sales Tax Act, 1964 (if any). .............. (7) Registration Number under the Central Sales Tax Act, 1956 (if any)........... (8) Constitution of the business (Tick whichever is applicable).............. Proprietorship Public limited company HUF Partnership Cooperative Society Pvt. Ltd. Company Government Department Others * *(To be specified if not covered by any of the given description) (9) Nature of business whichever is applicable (?) Manufacturing Leasing Retail Trade Wholesale Trade Hotel Works Contractor Mining Commission Agent Others (10) Four main class of commodities which the business deals in: 1. 3. 2. 4. (11) The turnover of sales during the year.....was of Rs.......and it first exceeded the limit as provided under Section 3 of the Act on........... (12) The business is succeeded from the dealer .............w.e.f ......... who is registered under TIN............. (13) Details of bank account (s) Name of the bank with address Type of account Account number ................... ........ ............ (14) Details of immovable properties owned wholly or partly by the business: Sr. No. Description of property Address where property is situated Approximate value Share percentage (15) The name(s) and addresse(s) of the proprietor/partners of the business/all persons having interest in the business/managing director of the company are as under: Sr. No Name of proprietor/ Partner or other persons Father's/Husband's Name Age Home address Signature (16) The proprietor or partner or any other person having interest in the business anywhere in India. Name of the proprietor/partner or any other person Names and particulars of the business Address of place of business (17) Language and script in which account books are maintained ......... (18) A copy of partnership deed, Memorandum of Association, etc, enclosed. (19) Passport size photograph of the proprietor, each of the partners, Karta of HUF, Managing Director, are affixed herebelow: DECLARATION I/We hereby declare that the above statements are true to the best of my/our knowledge and belief. Place:..... Signature:..... Date:....... Status:.......
