The Chhattisgarh Value Added Tax Rules, 2006. - FORMS
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FORM 10

[See Rule 11 (1)]

Application for grant of registration certificate under section 16, of the Chhattisgarh Value Added Tax Act, 2005.

To,

The Commercial Tax Officer.

______________Circle

I, __________ *Proprietor/Manager/Partner/Director of the business known as ______ / officer incharge of the business of selling or supplying goods carried on by the Central Government/ *State Government of ____________ in the ___________ department hereby apply for grant of registration certificate under clause (......) of sub-section (2) of section 16 of the Chhattisgarh Value Added Tax, 2005.

2. The particulars with regard to the business and the person (s) having interest in the business aforesaid, are as under , --

(i)	Name and full address of the business				_______________________________
(ii)	Status of Business (whether a proprietorship, partnership, a public limited or private limited company, H.U.F., Society, Co-operative Society, club or association.

(iii)	Nature of business with description of goods,-
	(a) Trading mainly in ___________
	(b) Manufacturing mainly _________
	(c) Mining of__________
(iv)	Name of the proprietor / Name of the partners/directors with full present and permanent address and extent of interest in the business :-

	Name	Address	Age	Father's Name	Home Address,Email address, phone No. Mobile No	Extent of Interest in business	Signature	Signature and address of the person attesting the signature in col. (7)
	(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)
1.
2.
3.

Note :- Attach passport size photograph of the proprietor or each of the adult partners of the firm or each adult co-parcener of HUF as the case may be, on a separate paper duly attested by a Lawyer or a Tax Practitioner or a Gazetted Officer.

(v)	Particulars about the proprietor, partner or any other person having interest in the business if he has interest in any other business anywhere in India, -
a)	Full name of the person
b)	Name(s) of the firm(s) with registration Certificate No. under Chhattisgarh Value Added Tax Act, 2005 and the Central Sales Tax Act.
c)	Full address
d)	Extent of interest
(vi)	Registration certificate number(s) under the State Sales Tax Act and the Central Sales Tax Act if the business is registered in any other State.
(vii)	Date of commencement of the business
(viii)	Turnover from the date of commencement of business to the date of making the application
(ix)	(a) Date on which the turnover exceeded the limit prescribed under sub-section (1) of section 4. (b) Date of liability to pay tax.
(x)	(a) If the turnover has not exceeded the limit prescribed under sub-section (1) of section 4, whether it is likely to exceed with in a period of twelve months from the date of commencement of the business. (b) If the turnover is likely to exceed as aforesaid, reasons therefor.
(xi)	If the business in respect of which the application is made is registered as an industrial unit with the Commerce and Industries Department of the Government of Chhattisgarh the number and date of the certificate
(xii)	Whether applied for registration certificate under the Central Sales Tax Act, 1956. If so the date of first interstate sale if the application has been made under section 7(1) of that Act.
(xiii)	(a) Number and date of Mandi licence if any, (enclose copy). (b) Number and date of licence under the Chhattisgarh Shops and Establishmentct if any (enclose copy). (c) Number and date of licence under the Essential Commodities Act, if any
	(enclose copy)

(xiv)	Particulars of immovable property owned by the persons having interest in the business
	S.No.	Name of the Person	Description and other particulars of the immovable property.	Extent of ownership in the immovable property.
	(1)	(2)	(3)	(4)


(xv)	Particulars of permanent account numbers (PAN) shall be mentioned compulsorily
	S.No.	Name of the Person	Permanent Account No.	Name and number of the Income Tax ward.
	(1)	(2)	(3)	(4)

(xva)	PAN of the business (specially for Company, Partnership firm, Co-society, H.U.F. and Association of person etc. ....................
(xvi)	Particular of the bankers through whom the business is transacted shall be mentioned compulsorily
	S.No.	Name of the Bank	Full address of the Bank	Bank account No.
	(1)	(2)	(3)	(4)

(xvii)	(a) Name and address of the additional places of business in the state, if any (b) Particulars of godowns/warehouses, if any

(xviii)	Particulars about the business premises (whether owned by any person or persons having interest in the business or taken on rent or on lease or allotted by the Govt.). If taken on rent or on lease enclose a copy of receipt of rent or lease deed.

3	Names and addresses of two dealers registered under the Chhattisgarh Value Added Tax Act, 2005 identifying the business. (enclose letters of identifications.)		(i)
3			(ii)

Place ...............	_______________
Date ...............	Signature

I, hereby declare that the statements made and particulars given are true to the best of my knowledge and belief .

Place ...............	_______________
Date ...............	Signature

*Strike out whichever is not applicable.

ACKNOWLEDGMENT

Received an application in form 10 for grant of registration certificate under clause (-) of subsection (2) of section 16 of the Chhattisgarh Value Added Tax Act, 2005 alongwith an affidavit from Shri _____________________.

Seal of Office
Place __________	___________________________
Date__________	Signature and full name of the official receiving the application.