FORM VAT - 1

"INFORMATION BY A DEALER, DEEMED TO BE REGISTERED UNDER THE ORISSA VALUE ADDED TAX ACT, 2004.

[See sub-rule (1) of rule 18 and sub-rule(4) of rule 19]

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 ……………………………………………………………… of .………………………………………… 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 value Added Tax Act, 2004.

  01. Name of the Business :

  02. Address of the Principal place or Place of business : (Principal place of Business, If there is more than one place of business) Village / Holding No  Locality Ward No Town / City P.O. PIN Phone :________________________Fax No.___________________. Email:______________

  03. Occupancy status of place of the business (Score out whichever is not applicable)

  Owned/ Rented/ Leased / Free Of Rent / Others(specify) ________

  04. Status of the business (Mark whichever is applicable)

  Proprietorship Partnership Public Ltd. Company Private ltd. Company Cooperative Society

  Association of persons. Public sector undertaking Department Government Others(specify)________

  05. Nature of business activities: (Mark whichever is applicable)

  Trading Manufacturing Mining Generation & Distribution of Electricity Leasing

  Execution of works contract Restaurateur Others(specify)_______

  06. Date from which liable to pay tax under the repealed Act.

  D D - M M - Y Y Y Y

  07. Date from which the certificate of registration was effective under the repealed Act and the Registration Number.

  D D - M M - Y Y Y Y                     R.C. No

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

  1. 2. 3. 4.

  5. 6. 7. 8.

  09. Are you manufacturing goods for sale ? (Score out whichever is not applicable) If answer is "Yes" furnish the following Details

  Yes No

  10. Description of goods purchased/Received otherwise for use as:	Capital goods.	Raw Materials.
  	1. 2.	1. 2.
  	Consumables
  	1. 2.
  	Fuel.	Packing Material
  	1. 2.	1. 2.

  11. Description of goods manufactured for sale including byproducts.		Taxable	Tax Free
  	Finished products.
  	By product

  12. Are you in receipt of any sales Tax incentive under IPR ? If your answer is "Yes" furnish the following details.

  Yes No

  13. Specify the IPR under which, incentive is being received and the nature of such incentive. (Score out whichever is not applicable)	IPR 1992 IPR 1996 IPR 2002
  	Exemption Deferment

  14. Specify the dates from which the incentive is being availed and the number of years or the total amount for which such incentive is admissible. (Mark " tick " whichever is applicable)	D D   M M   Y Y Y Y     -     -
  	No of Years Amount Incentive available

  15. Specify the number of years or the amount for which the incentive has already been availed.

  No of Years Amount Incentive already availed

  16. Are you engaged in mining operation? If your answer is "Yes" furnish the following details.

  Yes No

  17. Description of goods purchased for use in operation of mining.	Capital goods	Others (specify)
  	1. 2. 3. 4.	1. 2. 3. 4.

  18. Are you a works contractor? (Score out whichever is not applicable) If your answer is "Yes" furnish the following details.

  Yes No

  19. Nature of works contract executed. (Mark "tick " whichever is applicable)

  Civil Electrical Fabrication / erection Structural

  Air-conditioning Others ___________ (specify)

  20. Description of goods purchased for use in works contract.

  1. 2. 3. 4.

  5. 6. 7. 8.

  21. If you were registered u/s 9-c of the repealed Act, specify the date upto which your registration is valid.

  D D - M M - Y Y Y Y

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

  23. Permanent Account No. of the business (PAN)

  24. Language in which Books of Account are maintained.

  25. Are you maintaining accounts electronically? (Score out whichever is not applicable)

  Yes No

  26. Details of immovable property owned wholly or partly.	Description of property.	Address, where situated	Approx. Value	Share percentage

  27. Details of security, if any, furnished.	Amount of Security. Rs. P.	Manner in which furnished.

  28. Particulars of registration certificated issued. (i) By the Registrars of Companies. (ii) By the Registrar of Cooperative Societies. (iii) By the Supdt of Central Excise. (iv) By the Supdt of State Excise. (v) Under the Central Sales Tax Act, 1956 (vi) Under the Orissa Entry Tax Act, 1999 (vii) Under the Orissa Luxury Tax Act, (viii) Under the Orissa Act on Professions Trades, Calling & Employment, 2000

  29. Are you a member of any chamber of Commerce or Trade Organisation ? (score out whichever is not applicable) If your answer is "Yes" furnish the following details.

  Yes No

  30. The name of the Chamber or Trade organization and particulars , if any, in support of membership.

  31. Address of additional place(s) of business / branch / godown – both inside and outside the state.

  Use Form VAT - 101 - A / B

  32. Declaration of proprietor, each partner / Director, Authorised officer / person and Principal officer of the business.

  Use Form VAT - 101 - C

  33. The name and address of the Manager or Employee of the business or any other person associated with the business

  Use Form VAT - 101 - D

  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 notify immediately to the Registering authority to whom these particulars has been furnished, any change in any of the above particulars.

  Signature
  (Designation with relation to the business)
  Seal	Date _____/____/________