THE GOA VALUE ADDED TAX RULES, 2005 FORMS
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Form VAT XXXVI

[See Rule 14A(1)]

Application for the grant of certificate of Registration under section 18(9) of the Goa Value Added Tax Act, 2005 (Goa Act 9 of 2005)

Date : --------------------------------------

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I/We ___________________________ S/o ____________________ on behalf of the dealer conducting exhibition/event/programme for sales/sales promotion (tick whichever is applicable) whose particulars are given below, hereby apply for permission as required under section 18(9) of the Goa Value Added Tax Act, 2005.

1	Name, trade name and full postal address of the dealer with telephone, e-mail, fax, etc.	:
2	Particulars of TIN/CST RC No already held	:
3	Particulars of Commercial Tax Registration or CST Registration held in other State/s (copy of documents to be enclosed)	:
4	Particulars of premises where exhibition/ /event/programme is held (copy of documents to be enclosed)	:
5	Whether regular business place declared under GVAT Act or not	:
6	Particulars of lease/license/permission, etc. obtained with date (copy of documents to be enclosed)	:
7	Date of Commencement of exhibition/event/ /programme	:
8	Period for which the activity is to be carried on	:
9	Details of rent or licence fee paid to the owner of premises (copy of documents to be enclosed)	:
10	Description of locally procured goods involved with value (List to be attached)	:
11	Description of inter-State/imported goods involved with value (List to be attached)	:
12	Details of payment of fee under rule 14A(2) (Rs. 3000/- for each premises) (copy of documents to be enclosed)	:
13	Permanent address of the proprietor/partners/directors/president/secretary/manager etc. with details of PAN/ /passport/authenticated ID Card/telephone No./fax etc. (copy of documents to be enclosed). However, this is applicable only when dealer is not already registered under the GVAT Act, 2005).	:

Declaration

I/We _________________________ hereby declare that the information furnished herein are true, correct and complete to the best of my/our knowledge and belief.

Seal	Signature with name and status
Encl:- as above

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FOR OFFICE USE

Date of receipt _____________	Permission No.______________________
	Period Permitted_____________________
Details of payment of fee:
Commercial Tax Office/Ward: