Form ST - 1
[Application form for registration under Section 69 of the Finance Act, 1994 (32 of 1994)]
(Please tick appropriate box below)
(b) Address of the applicant
(b) If Yes, the PAN
(c) Name of the applicant (as appearing in PAN)
(ii) Partnership
(iii) Registered Public Limited Company
(iv) Registered Private Limited Company
(v) Registered Trust
(vi) Society/Cooperative society
(vii) Others
(b) Name, Address and Phone Number of Proprietor/Partner/Director(i) Name
(ii) Address
(iii) Phone Number
(b) Other person/class of persons
(b) Address of Premises for which Registration is sought
(i) Name of Premises / Building
(ii) Flat/Door/Block No.
(iii) Road/Street/Lane
(iv) Village / Area / Lane
(v) Block/Taluk/Sub-Division/Town
(vi) Post office
(vii)City/District
(viii)State/Union Territory
(ix) PIN
(x) Telephone Nos.:
(xi) Fax No.
(xii)E-mail Address
(c) In case of application for Centralized Registration, furnish address of all the premises from where taxable services are provided or intended to be provided (FORMAT AS PER 5(b) ABOVE) (d) In case of application for Input Service Distributor, furnish address of all the premises to which credit of input services is distributed or intended to be distributed (FORMAT AS PER 5(b) ABOVE)
8. Name, Designation and Address of the Authorized Signatory /Signatories:
DECLARATION
I, ___________________________________________hereby declare that the information given in this application form is true, correct and complete in every respect and that I am authorized to sign on behalf of the Registrant. (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: _______________(Original existing Registration Certificate is required to be enclosed)
ACKNOWLEDGEMENT
(To be given in the event Registration Certificate is not issued at the time of receipt of application for Registration)I hereby acknowledge the receipt of your Application Form
(a) For new Registration(As desired, the New Registration Certificate will be sent by E-MAIL/ mail/handed over to you in person on______________) (b) For amendments to information in existing Registration(I hereby acknowledge receipt of original existing Registration Certificate)
2. This notification shall come into force on the date of its publication in the Official Gazette.