FACT SHEET
FORM VAT-A2
[See rule 11(1) and 11(2)]
Information to be furnished by a dealer registered under the Act of 1973 or a dealer whose application submitted for registration under the Act is pending.
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 furnish the following information in respect of my business for the purpose of grant of registration certificate under sub rule (1)/sub rule (2) of Haryana Value Added Tax Rules 2003.
1. Name and Style of the business :
2. Registration Certificate Number under the
HGST Act, 1973.
3. Date of Liability
D
M
Y
4. Date of Validity
5. Date of submission of application for grant of
registration under HGST Act,1973 which is
pending on 01.04.2003.
6. Principal Place of Business and contact number(s).
Address
Phone:
City
Fax:
District
E-Mail:
7. Permanent Account Number of the business(PAN)
8. Constitution of the business ( ) 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)
9. Nature of Business( ) 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
10. Four principal commodities
which the business deals in.
11. EAC (Economic Activity Code)
(as per schedule I of VAT Rules )
12. Details of Bank Account(s)
Name of Bank with address
Type of account
Account Number
13. 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
.
14. Script in which account books are maintained.
15. 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 Annexure-I.
16. A copy of the partnership deed and Memorandum of Articles of Association is enclosed.
17. The details of additional place(s) of business are attached as Annexure-II.
18. The List of goods required to be purchased at concessional rate of tax under sub-section(4) of section 7 is attached as Annexure-III.
19. The details of security furnished are attached as Annexure-IV.
20. The details of closing stock as on 31.03.2003 are attached as Annexure – V.
21. Passport size (self signed) photograph(s) of the proprietor, each of the partner, Karta of HUF and each director(in case of private limited company) is/are pasted below.
Name
Status
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
(Signature of other partners in case of partnership business)
(1) Place........ Signature..........
(2) Place........ Signature.............
Full Name .............
Full Name ............
Date......... Status...................
(3) Place........ Signature..........
(4) Place........ Signature.............
______________________________________________________________________
(For office use only)
Acknowledgements receipt No. ............ Date ................ Ward No. ...........
Signature and Stamp of
section clerk
Annexure I
(to be attached with form VAT-A2)
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 ________________________________________________
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 House No. ____________ Sector/ Street ____________
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 -A2)
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
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 ______________________
Annexure-V
Details of Stock of goods (other than capital goods) as on 31.03.2003
1. Total value of the stock as on 31.03.2003 :
Rs. _________________
2. Value of goods out of (1) above which are lying in the form in which these were Purchased :
3. Value of manufactured goods including goods in process.
4. Break up of value of goods at (2) above
Stock of Goods as on 31.03.2003 (Value in Rupees)
Value of Goods purchased within the State
Value of
Goods
Purchased
Outside the
State
Tax Paid
Tax Free
Taxable (Purchased
without payment of tax)
Rate of Tax
Tax element
in value
Total:
5. Break up of estimation of value of goods used in the manufacture of goods at (3) above.
Total Estimated Value in Rupees
Place........... ...
Status.........................
Date................
Full Name .....................