The Orissa Value Added Tax Rules, 2005 FORMS
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FORM VAT-408

INTIMATION REGARDING PLACE OF BUSINESS/OFFICE/GODOWN OF CLEARING AND FORWARDING AGENT, BOOKING AGENT, BROKER OR TRANSPORTER

[Refer sub rule (1) of rule 85]

01. Name and address of Officer

D D

M M

Y Y Y Y

02. Name and full address of the clearing and forwarding agent/Booking agent Broker/Transporter.

03. Name and full address of the applicant (Permanent and Present)

04. The status of the applicant with relation of the business.

05. The nature of business

(Mark "v" whichever is applicable)

Clearing & forwarding agent

Booking agent

Broker

Transporter

06. The location with full address of the place of business/office/godown/warehouse.

07. The location and address of the additional place of business/office/godown/warehouse.

(a) In the same town/city

(b) in the State

08. In case of clearing and forwarding agent,

(i) the name and full address of the principal, the description of goods, they deal in

(ii) TIN, if any, of the principal,

(iii) the area covered

09. In case of booking agent/broker/Transporter,

(i) the number of Trucks or other conveyances deployed

(ii) the registration number and the name and full address of the owner of such Truck/Conveyance.

10. The date of commencement of business.

11. VERIFICATION:

1 ___________________ son/daughter/wife of ________________ (status) _____________of ___________ located at ______________ of ________________ P.S. Pin Code__________do hereby declare that the information furnished above is true to the best of my knowledge and belief.

Place ------------

Date ------------

Signature

(status)

Seal