FORM - 5 (See rule 5) Certificate of Registration under section 9(3) of the Goa Tax on Luxuries Act, 1988. No. ......... District ...... This is to certify that * Shri/ * Messrs. ............... * the ................ who/ which is carrying on the business known as ............., whereof the *only/ *chief place of business in the District of ........, is situated at Room/ Flat No. ......., Name of the Building ....... Municipal No. of the Building ..., Ward/ Locality .......Road ......., Village ........, Post Office ........, Taluka ......, has been registered as a hotelier under section 9 of the Goa Tax on Luxuries Act, 1988 with effect from ......... This hotelier has additional place/ places of business at the address specified below:- ........ ........ ........ Signature .......... Registration Authority Seal of Registration Authority. Place : Dated: (The registering authority will sign against the last entry at the time of issuing the Certificate and against any subsequent exclusion, addition or other amendment). * Strike out whichever is not applicable. * State here the name of Hindu undivided family/ firm/ company/ Corporation/ society/ club, association of individuals/ local authority/ trust/ Government etc.
