THE SERVICE TAX RULES - FORMS
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Body

FORM ST- 1A

[Application form for registration under section 69 of the Finance Act, 1994 (32 of 1994) for person in non-taxable territory providing online information and database access or retrieval services in India]

(Please tick appropriate box below)

New Registration

Amendments to information declared by the existing Registrant.

Registration Number in case of existing Registrant seeking Amendment.........................

1. (a) Name of applicant

(b) Trading name of applicant [if different from (a) above]

Unit No.

Complex (If applicable

Street No.

Street/ Farm Name

Suburb/ District

City/Town

Pin Code

Registered Physical address

Country (Full Name) :

(d) Postal Address Detail

[Complete this address if Postal Address is a Postal Box]

Postal Agency or other Sub Unit (if applicable)

PO Box

Private Bag

Other PO Special Services

Number

Post Office

Country Code

Postal/Zip Code

Registration Postal Code

Country (Full Name) :

(e) Applicant Website Uniform Resource Locators (URLs) through which taxable services are provided:

(i) .......................

(ii) .........................

(f) E-mail ID of the applicant:

2. Details of registration/business identification number/any unique identification number in the country of incorporation of the applicant

2A. Name of the applicant (as appearing in above identification number)

3. Name, Address and Phone Number of Proprietor/Partner/Director

(i) Name

(ii) Address

(iii) Phone Number

(iv) email ID

4. Category of Registrant

(i) Person liable to pay service tax

(ii) Online information and database access or retrieval services provider whose aggregate value of such services provided in taxable territory in a financial year exceeds nine lakh rupees.

5. Name, Designation, Address, Phone Number and email ID of the Authorised Signatory/Signatories:

(i) Name

(ii) Designation

(iii) Address

(iv) Phone Number

(v) email ID

6. Name, Designation, Address, PAN, Phone number and email ID of the Authorised agent in the taxable territory (if any):

(i) Name

(ii) Designation

(iii) Address

(iii) PAN

(iv) Phone Number

(v) email ID

DECLARATION

I, _ ................................ declare that the information given in this application form is true, correct and complete in every respect and that I am authorised to sign on behalf of the Registrant. I would charge and collect service tax from the non-assesse online recipient located in taxable territory and deposit the same with Government of India through internet.

(a) For new Registration: I would like to receive the Registration Certificate by mail / by hand/ E-MAIL

(b) For amendments to information pertaining to existing Registrant:

Date from which amendments are made:

Date..................	(Signature of the applicant/authorised person with stamp)
Place....................;