7. Type of Dealer: VAT u/s 3(2) u/s 5 (1) Others 8. Expected Turnover in Less than Rs. 5 lacs the current financial year Rs 5 lac and above but not exceeding Rs 50 lacs Above Rs 50 lacs 9. Nature of Business Manufacturer Retailer Leasing Wholesaler Works Contractor Exporter Others, please specify 10.Commodities dealt with Intend to Purchase Intend to sale 1._________________Code*_____ 1. _________________Code_____ 2._________________Code_____ 2. _________________Code_____ 3._________________Code_____ 3.__________________Code_____ 4._________________Code_____ 4.__________________Code_____ ................................................................. ................................................................... 11. Constitution of Business Proprietorship Partnership Private Ltd. Company Public Ltd. Company Public Sector Undertaking HUF Co-operative Society Club Trust Central / State Government Department Others,please specify ____________________________________________________________ 12.Particulars of the proprietor / 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. e-mail ID: 10. Personal identification (see rule 12(3)(vi)) 11. Details (including address) of all immovable property owned by or in which the person has interest/ 14. Details of security furnished 15.Bank Account information Factory Bldg. No/ Name/ Area Town/City District (State) Pin Code Telephone Number(s) Place : Date : Name : Status: Verification I / We certify that the information given in this form and its attachments (if any) is true and correct to the best of my knowledge and belief and nothing has been concealed. I also certify that R.C. No. (TIN) has not been previously issued to me / us. Place : Signature Date : Name of Applicant (s): Status with Seal Instructions: 1. Please read the instructions carefully 2. All the entries should be filled in capital letters 3. Tick . applicable in option boxes 4. If required, attach seperate sheet 5. The application should have the following attachments: (i) Declaration of business manager in Form VAT-02; (ii) Copy, of partnership deed, if any, memorandum and articles of association of a company, constitution deed of trust, association of persons or body of individuals, certified by the applicant; (iii) Copy of resolution passed by Board of Directors, in case of a company and of governing body, in case of other entities, for authorisation of a person to file the application for registration certified by the applicant; (iv) Signed photo duly attested by a gazetted officer or notary public of following:a) Proprietor, in case of Proprietorship concern; b) Every Partner, in case of Partnership firm; c) Managing Director / Director or authorized signatory, in case of a Company; d) Karta, in case of Hindu Undivided Family; and e) Authorised Signatory, in all other cases. (v) Copy of voter identification card or passport or Permanent Account Number or driving license. (vi) Copy of rent deed alongwith rent receipt, electricity bill or water bill. (vii) Own property documents, in support of address proof. (viii) Surety Bond in Form VAT-64 (ix) Securities (NSC or Receipt for deposit of cash), if surety bond is not submitted. 6. The application and all attachments are to be filed in duplicate 7. Any change in any of the particulars mentioned above should be intimated to the Department within 30 days. 8. 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 in case there is no partnership deed and in case of partnership deed by any one partner. 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 (i) (ii) (iii) & so on Receipt No. Dated: Signature of the receiving official with seal
