* State here firm, company, local authority, corporation, society, club, association, of individuals, Hindu undivided family, trust or Government. * To be signed by the hotelier or any person duly authorized by him. (For office use only) Date on which called ..... Place at which called ..... Officer before whom called ...... Signature of receiving Officer ACKNOWLEDGMENT Received an application in Form 4 from ....... for registration under section 9 of the Goa Tax on Luxuries Act, 1988. Sr. No. .... Date on which the applicant is called ...... Place at which the applicant is called ...... Officer before whom the applicant is called ...... Dated: .... Signature of Receiving Officer
