THE ASSAM GOODS AND SERVICES TAX FORMS 2017
GOODS AND SERVICE TAX PRACTITIONER

Body

Form GST PCT - 1

[See Rule 83(1) ]

Application for Enrolment as Goods and Services Tax Practitioner

Part -A

State /UT -

District -

(i)	Name of the Goods and Services Tax Practitioner (As mentioned in PAN)
(ii)	PAN
(iii)	Email Address
(iv)	Mobile Number
Note - Information submitted above is subject to online verification before proceeding to fill up Part-B.

PART B

Enrolling Authority

Centre
State

State/UT

Date of application

Enrolment sought as:

(1) Chartered Accountant holding COP

(2) Company Secretary holding COP

(3) Cost and Management Accountant holding COP

(4) Advocate

(5) Graduate or Postgraduate degree in Commerce

(6) Graduate or Postgraduate degree in Banking

(7) Graduate or Postgraduate degree in Business Administration

(8) Graduate or Postgraduate degree in Business Management

(9) Degree examination of any recognized Foreign University

(10) Retired Government Officials

(11) Sales Tax practitioner under existing law for a period of not less than five years

(12) tax return preparer under existing law for a period of not less than five years

Membership Number

5.1

Membership Type (drop down will change based the institute selected )

5.1

Date of Enrolment / Membership

5.2

Membership Valid upto

Advocates registered with Bar (Name of Bar Council)

6.1

Registration Number as given by Bar

6.2

Date of Registration

6.3

Valid up to

Retired Government Officials

Retired from Centre/ State

7.1

Date of Retirement

7.2

Designation of the post held at the time of retirement

Scanned copy of Pension Certificate issued by AG office or any other document evidencing retirement

Applicant Details

8.1

Full name as per PAN

8.2

Father's Name

8.3

Date of Birth

8.4

Photo

8.5

Gender

8.6

Aadhaar

8.7

PAN

< Pre filled from Part A>

8.8

Mobile Number

8.9

Landline Number

8.1

Email id

< Pre filled from Part A>

Professional Address

(Any three will be mandatory)

9.1

Building No./ Flat No./ Door No.

9.2

Floor No.

9.3

Name of the Premises / Building

9.4

Road / Street Lane

9.5

Locality / Area / Village

9.6

District

9.7

State

9.8

PIN Code

Qualification Details

10.1

Qualifying Degree

10.2

Affiliation University / Institute

Consent

Declaration

I hereby declare that:

(i) I am a citizen of India;

(ii) I am a person of sound mind;

(iii) I have not been adjudicated as an insolvent; and

(iv) I have not been convicted by a competent court.

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.

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

< DSC /E-sign of the Applicant/EVC>

Date

< Name of the Applicant>

Acknowledgment

Application Reference Number (ARN) -
You have filed the application successfully.
GSTIN, if available:
Legal Name:
Form No. :
Form Description :
Date of Filing:
Time of filing:
Center Jurisdiction:
State Jurisdiction :
Filed by :
Temporary reference number, (TRN) if any:
Place:

It is a system generated acknowledgement and does not require any signature.

Note - The status of the application can be viewed through "Track Application Status" at dash board on the GST Portal.