FORM VAT-A1
[See rule 11(5)]
Application for the Grant of Registration under Section 11 of the Haryana Value Added
Tax Act, 2003
To
The Assessing Authority,
................ District.
I/We ........................ Proprietor/Partner(s)/Karta of HUF/Principal Officer managing the business/affairs of the Company/Society/Association of Persons/Club/Head of the Department or any other officer duly authorised by him in writing, of the business, details of which are given below, hereby apply on behalf of the said business for grant of a certificate of registration under the Haryana Value Added Tax Act, 2003, for which a registration fee of Rs. 100.00 has been paid on............. vide TR No...... date.........../ by affixing Court fee stamp worth Rs.100.00 on this application :-
1. Name and Style of the business :
2. Principal Place of Business and contact number(s).
Address
Phone:
City
Fax:
District
E-Mail:
3. Permanent Account number of the business(PAN)
4. Constitution of the business (Ö ) whichever is applicable
Proprietorship
Public Limited Company
Board or Corporation
Government Department
Partnership
HUF
Association of Persons
*
Private Limited Company
Co-Operative Society
Club
*( To be specified if not covered by any of the given descriptions)
5. Nature of Business(Ö ) whichever is applicable
Manufacturing
B.K.O.
Whole Sale Trade
Leasing
Mining
Halwaii
Retail Trade
Rice Sheller
Power Generation / Distribution
Plyboard Manufacturer
Food grain Commission Agent
Stone Crusher
Works Contractor
Lottery Dealer
Eating Establishment
Other
6. Four principal commodities which the business deals in.
7. EAC (Economic Activity Code)
(as per schedule I of VAT Rules )
8. Basis of incurring liability to pay tax (Ö ) whichever is applicable.
Import
Export
Sale exceeding rupees one lac
Voluntary registration
9. Date of liability
D D - M M - Y Y Y Y
.
-
10. Details of Bank Account(s)
Name of Bank with address
Type of account
Account Number
11. Details of immovable properties owned wholly or partly by the business.
Sr. No.
Description of property
Address where property is situated
Approximate value
Share
Percentage
12. Script in which account books are maintained.
13. The names, addresses and other details of the proprietor, each of the partner, Karta of HUF and each director(in case of private limited company) are attached as per Annexure – I.
14. A copy of the partnership deed /Memorandum of Articles of Association is enclosed.
15. The details of additional place(s) of business are attached as per Annexure-II.
16. The list of goods required to be purchased at concessional rate of tax under sub-section(4) of section 7 is attached as per Annexure-III.
17. The details of security furnished are attached as per Annexure-IV.
18. Passport size (self signed) photographs of the proprietor, each of the partner, Karta of HUF and each director(in case of private limited company) are pasted below.
VERIFICATION
I/We ______________________________ do hereby solemnly affirm and declare that the information contained in this application, including annexures attached herewith, is true and correct to the best of my/our knowledge and belief.
Signature ......................
Place :
Status..........................
Date:
Full Name .......................
DECLARATION
(i) I/We hereby undertake to abide by the provisions of the Haryana Value Added Tax Act,2003 and the Haryana Value Added Tax Rules, 2003.
(ii) A sign board in the name of my/our business has already been displayed at all the business premises.
(iii) That the books of accounts in respect of the said business are being maintained and shall be found at the said business premises.
Place...........
Signature
Date
(Signature of other partners in case of partnership business)
(1) Place........ Signature.......... (2) Place........ Signature.............
Full Name ............. ; Full Name ............
Date......... Status................... Date......... Status...................
(3)Place........ Signature.......... (4)Place........ Signature.............
Full Name ............. 9; Full Name ............
______________________________________________________________________
(For office use only)
Acknowledgement receipt No. ............ Date ................ Ward No. ...........
Signature and Stamp of
section clerk
Annexure I
(to be attached with form VAT-A1)
Information about Proprietor, each Partner ( in case of partnership business)/Director ( in case of Private Company ) separately and Karta of HUF
1. Full Name in Capitals 9; ________________________________________________
2. Father’s Name in Capitals ________________________________________________
3. Status ; ; ; ________________________________________________
4. Extent of interest in business ________________________________________________
5. Permanent Address House No. ____________ Sector/ Street ____________
City _________________ District __________________
State ________________ Pin_____________________
6. Present Address
State ________________ Pin _____________________
7. Details of all immovable properties owned:
Sr. No
Full address where property is situated
Extent of share
8. Particulars of other business(s) in which the person has interest
Name of business
The above details are true and complete to the best of my knowledge and belief and nothing has been concealed therein.
Place____________
Date____________
Signature of the person concerned
Annexure- II
(to be attached with form VAT -A1)
Details of additional places of business
Complete Address
Use of premises-factory/ godown/ office/ sale outlet/ any other (to be specified)
Telephone
Number
The above details are true and complete to the best of my knowledge and belief and nothing has been concealed therein. I further declare that I shall inform the department whenever there is a change in the information provided in this annexure.
Signature ...................
Full name__________________
Status____________________
Annexure -III
(to be attached with form VAT –A1)
The List of goods required to be purchased at concessional rate of tax under
sub-section(4) of section 7.
(1)
Purpose for which required
(2)
Description of goods
(3)
1.
For use in manufacture of goods for sale.
2.
For use in telecommunication network.
3.
For use in mining.
4.
For use in generation or distribution of electricity or any other form of power.
5.
For use in packing of goods specified in Col.(3) of entries at Serials 1 to 4 above, as the case may be
Signature _________________________
Full Name ________________________
Status ____________________________
Annexure –IV
( Details of Security Furnished )
Name of the surety
Type of security
Amount
Name and TIN under the VAT Act of the business in which surety has an interest
Date of expiry (in case of bank guarantee)
Signature ___________________
Full name ___________________
Status ______________________