THE BIHAR GOODS AND SERVICES TAX FORMS 2017
REGISTRATION

Body

Form GST REG-12

[See Rule 16(1)]

Reference Number -	Date:

To
(Name):
(Address):
Temporary Registration Number

Order of Grant of Temporary Registration/ Suo Moto Registration

Whereas the undersigned has sufficient reason to believe that you are liable for registration under the Act, and therefore, you are hereby registered on a temporary basis. The particulars of the business as ascertained from the business premises are given as under:

Details of person to whom temporary registration granted
1.	Name and Legal Name, if applicable
2.	Gender		Male/Female/Other
3.	Father's Name
4.	Date of Birth		DD/MM/YYYY
5.	Adddress of the Person	Building No./ Flat No.
		Floor No.
		Name of Premises/ Building
		Road/ Street
		Town/City/Locality/ Village
		District/City
		State
		PIN Code
6.	Permenent Account Number of the person, if available
7.	Mobile No.
8.	Email Address
9.	Other ID, if any (Voter ID No./ Passport No./Driving License No./ Aadhaar No./ Other)
10.	Reasons for temporary registration
11.	Effective date of registration / temporary ID
12.	Registration No. / Temporary ID

13. Details of Bank Accounts (s) [Optional]

Total number of Bank Accounts maintained by the applicant (Upto 10 Bank Accounts to be reported)

Details of Bank Account 1

Account Number

Type of Account

IFSC

Bank Name

Branch Address

To be auto-populated (Edit mode)

Note-Add more bank accounts.

(Upload of Seizure Memo / Detention Memo / Any other supporting documents)

<<You are hereby directed to file application for proper registration within 30 days of the issue of this order>>

	Signature
Place	<< Name of the Officer>>:

Date:	Designation/ Jurisdiction:

Note: A copy of the order will be sent to the corresponding Central/ State Jurisdictional Authority.