"THE KERALA VALUE ADDED TAX RULES, 2005

FORM No.1G replaced with a new Form No. 1 w.e.f 01-04-2011

Application For Registration under Kerala Value Added Tax Act ,2003

[See Rule 17 (7B)]

The Registering Authority

I/We............ of .......... at .......... behalf of the dealer/carrying on business whose particulars are given below hereby apply for a registration under the Kerala Value Added Tax Act 2003.

(i) I/We agree to abide by all the provisions of the Kerala Value Added Tax Act, the Rules made there under and any orders issued there under.

(ii)The fee prescribed has been paid and the chalan is enclosed

(iii) I/We .......................... declare that to the best of my/our knowledge and belief the information furnished herein is true and complete.

Place:	Signature of the applicant.
Date:

SCHEDULE

1	Name and full postal address of the applicant (specify Trade name, Ward no., Bldg. No., Street name, Telephone, PAN, ID Card No. of the C.T. Dept.
2	Name and address of the Manager, if appointed
3	Nature of business
4	Name and full postal address of all other places of business in the State with building no. ward no., street name etc.
5	Complete list and full address of all godowns with building no. ward no., street name etc
6	Date of commencement of business (applicable for new applicants
7	Status of the applicant (specify whether Individual, Firm, Company, Society etc.
8	Details of proprietor/partners/Directors

Sl No.	Name	Age and Date of Birth	Present Residential Address with Pin code and Ph. No	Income Tax PAN & Details of Identity Cards like I.D. Card of C.T. Dept.	Signature	Name, address and signature of witness attesting the signature

9	Particulars of Registration Certificate under other statutes
10	Details of licence obtained from local authorities
11	Turnover, if any, for the year upto the submission of the application.
12	Particulars of payments of Registration fee for the principal place of business and/or additional places of business

Place:	Name, status and signature
Date:

(For official use)

1. Date of receipt of Application.

2. Nature of order passed by the assessing authority in the application

3. Registration certificate No. and date, if any issued.

4. Date of issue of registration certificate.

Signature of the .Registering Authority";