Form ENT-1 See rule 3(1) and 5(1) Application for grant of certificate of Registration / renewal of certificate of Registration To, The Commercial Tax Officer Ward Department of Commercial Taxes , Goa. Sir, I hereby apply for Registration / Renewal of the Certificate of Registration as per details given below (1) Name and Style of activity of providing entertainment (2) Address of the Place of entertainment Main Office Additional place 1 Additional place 2 Additional place 3 (3) Constitution of the entity providing entertainment ( Attach Documents) Nature Names and Address of Partners/ Proprietors/ Managing Director/ Office bearers/ Key persons 1. 2. 3. 4. 5. (4) Nature of Entertainment (5)(1)Registration No. under the Goa Value Added Tax Act, 2005 (if granted) (5)(2) Registration No. under the Goa Tax On Luxuries Act, 1988 (if granted) (5)(3 ) Registration No. under the Goa Entertainment Tax Act, 1964 (if granted) (For renewal cases) (5) (4) Bank Account No. (5) (5) PAN Details (6) Details of registration Fees Paid as per Schedule E Challan No./ Date Amount (7) Details of renewal Fees Paid as per Schedule E Challan No./ Date Amount (8) Details of lump sum paid as charges for admission as per Schedule D (For Hotels having Casinos) Challan No./ Date Amount Signature of the applicantStatus Full address for correspondence Date Place
