VAT- 05 [See Rule 16(1)] Application for Amendment in the Registration Certificate 1. Name of Dealer 2. Change in Name of Dealer New Name of Dealer 3. New Address of Pricipal Place of Business Date of change Bldg. No/ Name/Area Town/City District (State) Pin Code Telephone Number(s) 4. Type Factory If other please specify Godown Branch Others 1. _________________Code_____ 2. _________________Code_____ 3.__________________Code_____ 4.__________________Code_____ ................................................................... 1. _________________Code_____ 2. _________________Code_____ 3.__________________Code_____ 4.__________________Code_____ ..................................................................._ Others Nature of -Business Manufacturer Retailer Leasing Wholesaler Works Contractor Exporter Others, please specify TIN of seller Address Bldg. No/ Name/Area Town/City District (State) Pin Code Telephone Number(s) Email Id FAX No. 8. Sale or disposal of Business in part Name of business Date of disposal Nature of -Business 10.Details of outgoing & incoming partners / directors / Karta / Trustees / Members of the governing body/ authorised signatory: Incoming Outgoing 1. Full Name 2. Father's / Husband's Name 3. Age 4. Status 11. Change in particulars of the proprietor / partners / directors / Karta / Trustees / Members of the governing body/ authorised signatory, and particulars of incoming partners / directors / Karta / Trustees / Members of the governing body/ authorised signatory A. Particulars 1. Full Name 2. Father's / Husband's Name 3. Age 4. Status 6. Permanent address 7.Telephone no. 8. PAN (if any) 9. Details (incl address) of all immovable property owned by or in which the person has interest/ joint 10. Name & Address of witness B. Particulars of changes in interest in any other business (es) 1.Name of other business 2. Complete Address of other business 3. 5. 12 Change in surety 14. Any other change(s) Place : Signature Date : Name : Status : Verification I certify that the above information and its attachments (if any) is true and correct to the best of my knowledge and belief and nothing has been concealed. Place : Signature Date : Name : Status : Instructions: 1. Please read the instructions carefully 2. All the entries should be filled in capital letters 3. Tick . applicable in option boxes 4. The application should be filed in duplicate. 5. This Form should be verified and signed by. a. Proprietor, in case of Proprietorship concern. b. Managing Partner, in case of Partnership firm and where there is no Managing Partner, by all the partners if there is no registered partnership deed and in case of a registered partnership deed by any one of them. c. Managing Director or authorized signatory, in case of a Company. d. Karta, in case of Hindu Undivided Family. e. Authorised Signatory, in all other cases 6. Enclose supporting documents. 7. Enclose orginal copy of Registratiion Certificate which is required to be amended.
