THE GOA GOODS AND SERVICES TAX FORMS 2017
ACCOUNTS AND RECORDS

Body

Form GST ENR-01

[See Rule58(1)]

Application for Enrolment u/s 35 (2)

[only for un-registered persons]

Name of the State

(a) Legal name

(b) Trade Name, if any

(d) Aadhaar (applicable in case of proprietorship concerns only)

Type of enrolment

(i) Warehouse or Depot		(ii) Godown
(iii) Transporter		(iv) Cold storage

Constitution of Business (Please Select the Appropriate)

(i) Proprietorship Or HUF		(ii) Partnership
(iii) Company		(iv) Others

Particulars of Principal Place of Business

(a)

Address

Building No./Flat No.		Floor No.
Name of the Premise s/Building		Road/Street
City/Town/Locality/Village		Taluka/Block
District
State		PIN Code
Latitude		Longitude

(b)

Contact Information (the email address and mobile number will be used for authentication)

Office Email Address		Telephone	STD
Mobile Number		Fax	STD

(c)

Nature of premises

Own

Leased

Rented

Consent

Shared

Others (specify)

Details of additional place of business - Add for additional place(s) of business, if any (Fill up the same information as in item 5 [(a), (b), (c) & (d)]

7.. Consent

I on behalf of the holder of Aadhaar number <pre-filled based on Aadhaar number provided in the form> give consent to "Goods and Services Tax Network" to obtain my details from UIDAI for the purpose of authentication. "Goods and Services Tax Network" has informed me that identity information would only be used for validating identity of the Aadhaar holder and will be shared with Central Identities Data Repository only for the purpose of authentication.

8. List of documents uploaded

(Identity and address proof)

9. Verification

I hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief and nothing has been concealed therefrom.

Place:	Signature
Date:	Name of Authorized Signatory ...................................
For office use -
Enrolment no. -	Date -