PRESS CTRL-P TO PRINT BACK FORM L.T. XI (See rule3-A of the Himachal Pradesh Tax on Luxuries (in Hotels and Lodging Houses) Rules, 1979) APPLICATION FOR REGISTRATION BY THE PROPRIETOR OF A HOTEL To The Assessing Authority, ...... District. I/We ......... proprietor (Head of a Government Department or Head of Public Sector Undertaking) carrying on the business which is known as .......... whose head office in Himachal Pradesh is situated at ............. hereby apply for a certificate of registration under the Himachal Pradesh Tax on Luxuries (in Hotels and Lodging Houses) Act, 1979 and attach herewith a treasury/bank receipt of Rs. 25/- (Rupees twenty-five) only being registration fee. 2. The details of business are:- Serial Name of the Class(es) of No. of rooms available No. hotel, its location accommodation in each class of interest remitted provided accommodation and the branches, if any. 1 2. 3. 4 http://hptax.nic.in/ltf6.htm 4/11/08 http://hptax.nic.in/ltf6.htm 4/11/08 Rent fixed under the Items of boarding Charges for items mentioned Himachal Pradesh provided in the column 6 when Registration of sold to persons staying in the Hotels and Travel hotel. Act, 1988 5. 6. 7. a. bed tea, b. breakfast, c. lunch, d. evening tea, e. dinner, f. any other item. Details of material served under Charges for items mentioned in Column 6. column 6, when sold to person not staying in the hotel 8. 9. Charges for:- a. Air-ConditioningConcessional rateCharges for residence b. Telephonein relation to each classfor which luxury tax is c. Televisionfor luxury provided in the payable for each class d. Radiohotelof accommodation. e. Music and the like f. Extra beds 10 11 12 2. The name and address of the proprietor/partners/all persons having any interest in the business together with their age, father's name, permanent home address etc. are as under (to be filled in if the applicant is not a Company incorporated under the Indian Companies Act or any other laws):- Serial Name in Father's/ Age Extent of interest No. full Husband's in the business name. 1. 2. 3. 4. 5. http://hptax.nic.in/ltf6.htm 4/11/08 Present Permanent Signature *Signature and address Address address of witness attesting signature in column No. 8 6 7 8 9 * Signature of each of the persons concerned should be obtained and attested. (Note:- In the case of Government Department or Undertaking, the name of the Department or Undertaking and officer in-charge thereof need only be given). 3. The proprietor/any partner/any other persons having interest in the businesses, has interest in no other business anywhere in India, has interest in the following other business in India:- Name of the Name of particulars Address and name Proprietor/partner of the business of business or other person 1 2 3 (Note.- In the case of Government Department or Undertaking, the name of the Department or Undertaking and officer in-charge thereof need only be given.) 4. The business in respect of which the application is made, has been registered with the Registrar of Joint Stock Companies, Himachal Pradesh, or by any other registering authority in India in respect of the business (if registered in any other State, Name of the State.....) 5. The proprietor/partner/other persons is/are members of .......... (here insert the name of the Chamber of Commerce or Trade Association of which the proprietor is a member). 6. The business keeps accounts in .......... script. 7. The annual accounts/six monthly accounts are made up-to-date at the end of every year/half http://hptax.nic.in/ltf6.htm 4/11/08 year. 8. The business has the following places of business and no other:- DECLARATION I hereby declare that the above statements are true and complete to the best of my knowledge and belief. Place...... Signature of the proprietor. Date ...... ACKNOWLEDGEMENT Received from M/s ............ application in Form L.T. XII alongwith enclosures mentioned therein. Place...... Date ...... ............. Receiving Officer/Official http://hptax.nic.in/ltf6.htm 4/11/08
