Instructions:

1. To be submitted in duplicate
2. This Form should be signed by:

   a) Proprietor, in case of Proprietorship concern

   b) All Partners, in case of Partnership firm

   c) Managing Director or authorized signatory, in case of a Company

   d) Karta, in case of Hindu Undivided Family

   e) Authorized Signatory, in all other cases

1. Use separate form for each person declared as Business Manager
2. Passport size photograph of the Business Manager to be pasted above.

   1. Name of the Business : ______________________________

   2. TIN ___________________________ / Registration No_________________/TOT/CT

   3. Full Name of the Business Manager:	_____________________________
   4. Permanent address of the Business Manager:	_____________________________
   5. Present address of the Business Manager:	_____________________________
   6. Date from which authorized to act as Business Manager	_____________________________

   7. Specimen signatures (i) ____________________ (ii)____________________________

   8. Particulars of other persons who are authorized to receive notices and other

   documents under the Act.

   	Name _________________________________________________
   	Address_______________________________________________
   	Signature______________________________________________
   	Name _________________________________________________
   	Address_______________________________________________
   	Signature______________________________________________

   Declaration:

   I/We declare that the person named above whose specimen signatures are appended in column 7 is authorized to act as a Business Manager for the above referred business for which application for registration is being filed under the Jammu and Kashmir Value Added Act,2005. His all actions in relation to this business will be binding on me/us. He is also authorized to receive notices and other documents under the Act. I/we also authorize the person/persons whose particulars are given in column 8, to receive notices and other documents under the Act and to act as my/our authorised signatory.

   .

   Signatories

   Full Name	Signature	Status	Extent of interest in business

   (Please write names of all signatories and attach another sheet, if space is inadequate)

   Acceptance as a Business Manager	Acceptance of the person(s) authorized to receive notices etc
   I, accept to act as a Business Manager for the above referred business	I, accept to receive notices and other documents under the Act
   Signature ________________________	Signature ________________________
   Name ________________________	Name ________________________
   Parentage ________________________	Parentage ________________________
   Address ________________________	Address ________________________
   Date ________________________	Date ________________________

   (Attach additional sheet if space is inadequate)

   Verification

   The above details are true and correct to the best of my knowledge and belief and that nothing has been concealed therein. I/we further declare that I/we shall inform the Department whenever there is a change in the information provided in this form.

   Place ____________________	Signature ____________
   Date _____________________	Full name____________
   	Status________________
   	Seal _________________