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The Orissa Entry Tax - Forms
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FORM E17

[See rule 4 (1) (b)]

APPLICATION FOR REGISTRATION

Please read the following before filling up the form

* Submit in duplicate,

* Use separate sheet where space provided is insufficient,

* Use legible capital letters.

* Mention the Registering authority to whom the application is submitted.

To

The Registering Authority,

CIRCLE  

I ........................................................................son/daughter/wife of ................................................... the Proprietor / Partner / Karta of HUF / (Managing) Director / Principal officer / Authorised Departmental officer of the business, the particulars of which are detailed below, hereby apply on behalf of that business for grant of a certificate of registration under the Orissa Entry Tax Act, 1999.

01. Name of the business_________________________________.
02. Address of the Place of business/
  Principal place of business, if there is more than
  one place of business_______________________________
  Village/ Holding No:
  Locality /Ward No:
  Town /City
  Police Station
  P.O: Pin  
  Phone: FAX No. E-Mail:

(if there is more than one place of business, please mention all the additional places including Godowns/warehouses in addition to the principal place of business)

03. Occupancy status of place of business  
  (Score out whichever is not applicable) Owned/Rented/Leased/Free of Rent/Others (specify)

04. Status of the business (Mark "Tick" whichever is applicable) * Proprietorship * Hindu undivided family
  * Partnership * Public sector undertaking
  * Public Ltd. Company * Department of Government
      * Private Ltd. Company * Others (specify)
      * Cooperative Society  
      * Association of persons  

05. Nature of the business activities: (Mark "Tick" whichever is applicable) * Trading * Execution of works contract
  * Manufacturing * Restaurateur
  * Mining * Others (specify)
  * Generation & Distribution of Electricity  
      * Leasing  
     

06.Description of Commodities purchased or received otherwise than by way of purchases for resale/sale.

1. 5.
2. 6.
3. 7.
4. 8.

07. Date of commencement of business
Date Month Year
     
 

08. Date of commencement of liability to be registered under the Orissa Value Added Tax Act, 2004
Date Month Year
   
   
 		    
 
09. Description of goods manufactured for sale including by - products.
Finished products
By-products
 
10. The anticipated date of commencement of commercial production.
Date Month Year
   
   
 		    
 

11. Are you engaged in mining?

If you answer "Yes", furnish the following detail
Yes No
 

12.
Description of goods purchased for use in operation of mining

Capital goods Others (specify)
1. 1.
2. 2.
3. 3.
4. 4.
 

13. Are you a works contractor?

If you answer "Yes", furnish the following details.

Yes No

14. Nature of works contract executed. (Mark "Tick" whichever is applicable) * Civil * Air conditioning
  * Electrical * Others ----------- (specify)
  * Fabrication/erection  
  * structural  

15. Description of goods purchased for use in the execution of works
1. 1.
2. 2.
3. 3.
4. 4.
 
16.
Details of Bank Accouns

Name of the Bank Branch & Code Account No. Nature of Account
       
       
       
 

17. Income Tax PAN

(Permanent Account Number)

 
 
18. Language in which Books of Account are maintained.  
19. Are your accounts maintained electronically?

(score out whichever is not applicable)

Yes No
20. Particulars of registration certificate issued by the Registrar of Companies/ Registrar of Cooperative Societies/ Superintendent Excise or any other Registering authority in India including the Director of Industries.  
21.

Are you a member of any chamber of Commerce or Trade Organisation ? Yes No
(score out whichever is not applicable)  
If your answer is "Yes", furnish the following details.  
22. The name of the Chamber or Trade organisation and particulars, if any in support of such membership.  
23. Address of additional place (s) of business / branch/ godown- inside the State. Use Form E 17A
24. Declaration of proprietor, each partner/ Director, Authorised officer/ person and Principal officer of the business. Use Form E 17B
25.
Details of immovable property owned wholly or partly by the business

Description of property Address,where situated Approx. Value Share percentage
       
       
 

VERIFICATION

I --------------------------------------------------------son/daughter/wife of ----------------------------------------- status --------------------------------of the aforesaid business do hereby solemnly affirm that the particulars given in this form are true and correct to the best of my knowledge and belief. I undertake to intimate immediately to the Registering authority to whom the application has been made any change in any of the above particulars.

Signature

(Designation with relation to the business)

Date Month Year
     
 
Seal  
   

Enclosure to be annexed to the application for registration.

1. Rent agreement.

2. Deed of Partnership (copy)

3. Article of Association & Memorandum

4. Authorisation, if any, in original.

5. Declaration.

6. Voter identity Card (copy)

7. PAN (copy)

8. Others (please specify)