Form ENT-IV See rule 6(1) Application for cancellation of certificate of registration under section 3G (7) of the Goa Entertainment Tax Act, 1964 (To be filed in Duplicate) To, The Commercial Tax Officer Ward Department of Commercial Taxes Goa Sir, I hereby apply for cancellation of Certificate of Registration under the Goa Entertainment Tax Act, 1964 as per details given below (1a) Name and Style of activity of providing entertainment (1b) Registration No. (2) Address of the Place of entertainment Main Office Additional place 1 Additional place 2 Additional place 3 (3) Reasons for seeking cancellation of Registration Signature of the applicant ............. Status:......... Full address for future correspondence Encl: Original Certificate of Registration The above application was considered by the undersigned in accordance with the duly laid down procedure and having considered all the facts, I, in exercise of powers delegated under the Goa Entertainment Tax Act, 1964 hereby accept the application and cancel the Registration Certificate with effect from________/reject the same for grounds given below. Grounds for rejection if application not accepted A copy of this order is given to the applicant. The original papers are retained for records (Signature and Name of Assessing Authority) Place Date with seal
