Download Application for the Grant of Registration Certificate as a Dealer

FORM 1 [See rule 4(2)] Application for the grant of a registration certificate as a dealer under Goa Tax on Entry of Goods Act, 2000 To, The Registration Authority, ............., ............., .......... I, ......................... Son of .................... carrying on business whose particulars are given below, hereby apply for registration under Rule 4 of the Goa Tax on Entry of Goods Rules, 2000. (1) Name and full address of the applicant (if there is trade name the trade name shall be given) .................... ............................... (2) Name and address of the Manager of the business, if a Manager has been so appointed ...................... .............................. (3) Name and address and status of the person who signs this application (as regards status, state whether proprietor, manager, director, partner ............................ ............................... (4) Name and full postal address of the principal place of business (with particulars of building, name and number, ward name and number, road name, street name etc.) ...................... ............................... (5) Name and full postal address of all the other places of business elsewhere in the State with particulars of building and number, ward name particulars of building name and number, ward name and number, road name, street name, etc., for each place of business (if the space in this column is found to be insufficient additional sheet may be used and duly signed) ............................ ............................... (6) Complete list of godown in which the (scheduled goods) are stored and address of every such godown ................... ............................... (7) Date of commencement of business ............ ............................... (8) The language in which the accounts are kept and maintained .. ............................... (9) The accounting year followed by the applicant ......... ................................ (10) Whether the applicant is a proprietor, firm, company, society club, association of persons, Hindu undivided family, or trust, etc. (here give full description) ....................... ............................... (11) Names(s) and address(es) of the proprietor, firm, company, members, all persons having any interest in the business (additional sheets with the following columns shall be used, if necessary.) ........ ............................... Sl. No. Name in full of each person Name of father of each person Age of each person Perma- nent postal address of each person Present postal address of each person Extent of interest of each person in the business Signature of person Name, address and signature of witness attesting signature (1) (2) (3) (4) (5) (6) (7) (8) (9) (12) Whether business is wholesale, or mainly wholesale and partly retail, whether manufacturer etc. (here enter the general nature of business conducted by the dealer) ...................... ............................... (13) The total value of purchases/stock receipts of scheduled goods in the year preceding that to which the application is submitted ........ ............................... (14) Actual value of purchases/sock receipts of scheduled goods in the year upto the date of submission of the application ........... ............................... (15) Amount of registration fee paid with particulars of Receipt No. and date ............................................ (16) Amount of fee paid for copies of certificate for the other places of business with particulars of receipt No. and date, challan No. and date, cheque No. and date/name of the Treasury/Bank etc. ......... ............................... DECLARATION I, .................... son of .... ........... hereby declare that to the best of my knowledge and belief the information contained in this application given above is true and correct. Place: Dated: Name, address and signature if the person signing with status and relationship to the dealer (here state manager, director, partner, etc.) (for official use by the Registration Authority) (1) Date of receipt of application ............... (2) Nature of order passed by the Registering Authority in the application ....................... (3) Licence No. and date, if any .............. (4) Date of issue of registration certificate .......... ____________________________ Signature of the registering authority with date