THE UTTARAKHAND (THE UTTARANCHAL VALUE ADDED TAX RULES, 2005) FORMS
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FORM I (C)

(See sub-rule (1) of rule 12)

APPLICATION FOR REGISTRATION OF A CASUAL DEALER UNDER THE UTTARANCHAL VALUE ADDED TAX ACT, 2005.

To,

The Assessing Authority, Commercial Tax

Sector__________Circle___________

1-(a) Name of applicant:	------------------------------------------------------------------------------------
(b) Father's /Husband's name:	------------------------------------------------------------------------------------
(c ) Residential address:	------------------------------------------------------------------------------------
(d) Status in business :	------------------------------------------------------------------------------------
2-Name and style of business -	------------------------------------------------------------------------------------
3- Principal place of business :	------------------------------------------------------------------------------------
In Uttaranchal with complete address:	------------------------------------------------------------------------------------ Tel.Ph.No.----------------Fax------------------e-mail--------------------------
4- Name and address of Registered/Head office, if situated outside Uttaranchal with Sales Tax Registration Nos.	------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------ Registration No.(State)--------------------(C.S.T.)------------------------------------- Tel.Ph.No.--------------Fax-------------------e-mail------------ ----------------------

5-Name and address of all other places of business including depots and branches in Uttaranchal:

Sl. No.	Address of business place	Name and complete address of owner of the premises	Telephone number	If rented premises
Sl. No.	Address of business place	Name and complete address of owner of the premises	Telephone number	Amount of rent per month	Date from which taken on rent
1-
2-
3-
4-

6-Details of particulars of Proprietor/ Partners/ Members and Karta of Joint Hindu Family/ Trustee/ Receiver or Guardian of a minor or incapacitated person (as the case may be):

Sl. No.	Name	Father's/Husband's Name	Age	Permanent residential address	Signature
Sl. No.	Name	Father's/Husband's Name	Age
1-
2-
3-
4-

7-Period for which Registration is required:

From ----------------To---------------------

8-Details of deposit of Registration fees (including late fee, if any)

Treasury challan No. --------------------Dated -------------------

Amount Rs.------------(Registration fees ---------Late fee-----)

Name of Bank (with Branch)/ ----------------------------------

Treasury or Sub-Treasury ------------------------------------------

Passport size photograph of the applicant to be affixed

DECLARATION

I, --------------------------------------------(applicant) do hereby

declare that the particulars furnished in this application are true and complete to the best of my knowledge and belief, and no material particular has been concealed.

Place :--------------------	Signature of the applicant ------------------------------
Dated:---------------------	Name : -------------------------------------------------
	Status in business -------------------------------------

	(SEAL)

WITNESS :	(1)	-------------------------------------	(2)	-------------------------------------
Signature		-------------------------------------		-------------------------------------
Name :		-------------------------------------		-------------------------------------
Parentage :		-------------------------------------		-------------------------------------
Full address :		-------------------------------------		-------------------------------------
		-------------------------------------		-------------------------------------

Signature and details of the person who has attested signature and photograph of the applicant

Signature :

-------------------------------------

Name :

-------------------------------------

Status :

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(SEAL)

Annexure I FORM I (C)

1-(a) Name of the dealer and address	------------------------------------------------------------------------------------
2-Nature of business :	------------------------------------------------------------------------------------
3- Description oof goods in which business is carried on and the value of stock-in-hand at the time of commencement of business

Sl. No.	Broad category of goods		Stock of goods purchased within the State	Stock of goods purchased/received from outside the State
	Code No.	Commodity
1-
2-
3-
4-
5-
Total

4- Tentative period of business :	From---------------------------To----------------------
5- Estimated turnover of sale of goods	Rs.----------------------------------------------
6-Estimated liability of tax for one month or such lesser period for which business is intended to be conducted:	Rs.----------------------------------------------
7-Description of goods intended to be purchased or likely to be received from outside Uttaranchal:	---------------------------------------------------------- ----------------------------------------------------------
8- Estimated number of Declaration Forms required for import of goods from outside Uttaranchal:	----------------------------------------------------------

Declaration

I, ----------------------------------being------------------------(Status, i.e., Proprietor, Partner, Director etc .) of the business known as -----------------------------------------------------do hereby declare and verify that, to the best of my knowledge and belief, the information and particulars given above are true and complete and nothing has been willfully omitted or wrongly stated.

Signature :

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Date :

Name :

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Status :

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