The Assam Value Added Tax Rules, 2005. Forms
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THE ASSAM VALUE ADDED TAX RULES, 2005

FORM-4

[See Rule 13(13)]

APPLICATION FOR GENERAL REGISTRATION NUMBER (GRN)

The Prescribed Authority,

.............................................

Affix passport size photo of applicant.

I ...................................................... son of ............................................. on behalf of the dealer carrying on business whose particulars are given below, hereby apply for registration under Section ................ of the Assam Value Added Tax Act, 2003.

01. Name and style of the business.

02. Full address of place of business.

Building name/No.

Area/Road

Locality/Market

Pin Code

E-mail ID

Telephone No.

Fax Number

03. Status of business (Put tick mark where applicable).

Sole proprietorship	Association of person	Co-operative Society	*
Partnership	Private Ltd. Co.	Government Enterprise
HUF	Public Ltd. Co.	Other

*(To be specified if not covered by any of the given descriptions).

04. Nature of principle business activities (Put tick mark where applicable).

Manufacturing	Exporter	Importer	Distributor	C&F Agent	Wholeseller/ Stockist

Retailer	Works contractor	Leasing	Hotel	Hire purchase	Other (Specify)

05. Name of the principle commodities.

06. Occupancy status (Put tick mark where applicable).

Owned	Rented	Leased	Rent free	Other (Specify)

07. Name and address of the Proprietor/Managing Partner/Karta/Managing Director.

Name

Father's/Husband Name

Building name/No.

Area/Road

Locality/Market

Pin Code

E-mail ID

Telephone No.

Fax Number

08. Additional places of business/warehouse/godown inside the State

09. Date of Commencement of business

D	D	-	M	M	-	Y	Y	Y	Y

10. Date of liability.

D	D	-	M	M	-	Y	Y	Y	Y

11. Actual turnover of the year upto the date of submission of the application (with details of each category):

12. The estimated turnover for the year in which the application is submitted (furnish details, if any):

13. Income Tax Permanent Account No. (PAN), if any:

14. Details of Bank Account(s).

Name of Bank with address	Type of account	Account number

15. The language in which the accounts are maintained:

16. Do you use a computer for accounting? (Yes/No):

DECLARATION

(i) I/We do hereby undertake to pay the tax and file the return in the prescribed form in accordance with the provisions of the Assam Value Added Tax Rules, 2005 pertaining to the entire business conducted at my/our various places of business in accordance with the provisions of the Act and the rules made thereunder,

(ii) That a sign board in the name of my/our business has already been displayed at all the said business premises,

(iii) That the books of accounts in respect of the said business are being maintained and shall be found at the said business premises,

I/We ............................................ do hereby solemnly affirm and declare that above provided information is true and correct to the best of my/our knowledge and belief and that the undertaking given by me/ us shall be maintained by me/us so long as the registration of the said business under the Assam Value Added Tax Act, 2003, remains in force or till the liability under that Act is discharged.

Place................................	Signature
	Status...................................................
Date..................................	Name in CAPITALS ............................

Name, address, signature and T1N/GRN of two witnesses

attesting signature (1)......................................(2)...........................................

FOR OFFICE USE ONLY

1	Date of receipt of application:
2	Effective date of registration:
3	Date of certification by Prescribed Authority
4	Date of refusal of registration by Prescribed Authority
5	General Registration Number (GRN)