FORM IV TRIPURA VALUE ADDED TAX ACT, 2004 Application Form For Registration Of Transporter, Carrier Or Transporting Agent ( Under Rule 17(1) of TVAT Rules ) Write clearly in black ink and use BLOCK LETTERS To The Superintendent of Taxes Charge :________________ Affix a Photograph of the Signatory 1. Name of the Applicant : ______________________________________________ 2. Status of the Applicant (Proprietor, Director etc) : __________________________ 3. Name of the Transporter, Carrier _______________________________________ Or Transporting Agent 4. Address of Head Office _____________________________Tel. No. ___________ 5. Name and Address of Proprietor, Partner, Director etc. Sl.No. Name Father's Name Age Extent of Interest in the Business Present Address Permanent Address 1 2 3 4 5 6 7 6. Name(s) and Address of Other Place(s) of Business in the State of Tripura Sl.No. Name Address 1 2 3 7. Location and Address(es) of Godowns in Tripura Sl.No. Address of Godown 1 2 8. Particulars of Truck / Lorries in the Name of the Transport Company itself Sl.No. Registration No. with Transport Department Valid Up to 1 2 3 9. Particulars of Immovable Property Including Landed Property of Proprietors / Partners Sl.No. Details of Property 1 2 10. Bank Accounts of Transport Proprietor and Partners and Nature of Account Hold Sl.No. Name Name of Banker A/c Number and Nature of A/c 1 2 3 4 11. PAN Number of the Firm ____________________________________ 12. We keep our account in language and scrip in ___________________ Place : Signature of Applicant Date : Designation & Seal 13. Introduced By (Registered Transporter or any Responsible Person) _____________ FOR OFFICE USE ONLY Date of Registration : Day ______ Month ______ Year ______ Registration Number : ___________________________________ Amount of Security Paid : (Rs.) _______________________________ Bank Scroll No. : __________ Date ____________ Remarks, if any _______________________________________________
