FORM VAT-103

REGISTRATION CERTIFICATE FOR DEALERS LIABLE TO PAY

VALUE ADDED TAX

[See Sub rule (1) of rule 18, sub rule (1) and (2) of rule 19]

I hereby certify that _______________________________________ status ___________________, whose principal business activities comprise ________________________ and whose Principal place of business/place of business is situated at : -

Village/Holding No.

Locality

Ward No.

Corporation/Municipality/N.A.C./

Town/City.

Police Station

District

is registered/is deemed to be registered under sub section (2)/sub section (5) of Section 25 or sub section (2) of Section 26 of the Orissa Value Added Tax Act, 2004 and is assigned with Identification Number.

02. The additional place of business, branch, go down or warehouse is situated at the following address:

03. The following goods or class or classes of goods are purchased or intended to be purchased to be purchased or received otherwise than by way purchases for resale or sale.

04. The following goods are purchased or intended to be purchased or received otherwise than by way of purchases for use as capital goods, raw materials, consumables, fuels directly in the manufacture of goods and packing materials, for sale.

05. The following goods are manufactured or produced as bye-product for sale:

06. The following goods are purchased or intended to be purchased or received otherwise than by way of purchases for use in the execution of works contract.

07. Given under my hand at ______________ on the _____________ day of ________200......

Note:

Score out whichever is not applicable

Use block letter

No box shall be left blank

When not applicable, the box shall be crossed and stamped "NOT APPLICABLE".

Registration Certificate shall be displayed at a conspicuous place of Principal place of business.

Copy of Registration Certificate shall be displayed at a conspicuous place of each additional place of business mentioned in such Certificate.