The Jharkhand Value Added Tax Forms , 2005
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FORM VAT 100

GOVERNMENT OF JHARKHAND

COMMERCIAL TAXES DEPARTMENT

APPLICATION FOR VAT REGISTRATION

[See Rule 3(i) and 3(x)(a)]

Information to be furnished by a dealer registered under the Adopted Bihar Finance Act, 1981 or a dealer whose Application submitted for Registration under the Act ibid, is pending.

The Registering Authority

....................... Circle/Sub-Circle.

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 3(i) of Jharkhand VAT Rules 06.

Name of the Dealer :

Registration Certificate Number under the

Adopted Bihar Finance Act 1981 (Part-I).

Registration Certificate Number under the Central Sales Tax Act 1956.

Date of Liability

D	D	-	M	M	-	Y	Y

Date of Validity

Date of submission of Application for grant of Registration under Jharkhand VAT Act 05, which is pending as on Appointed Day [See Rule 3(ii)].

Principal Place of Business and contact number(s).

Address	Phone/Mobile :
City	Fax:
District	E-Mail:

Permanent Account Number of the Dealer(s)/Business (PAN)

Proprietorship	Public Limited Company	Board or Corporation	Government Department
Partnership	HUF	Association of Persons	Others
Private Limited Company	Co-Operative Society	Club

10. Nature of Business ("Tick") whichever is applicable

Manufacturing	Exporter	Distributor	Local Authority
Mining	Whole Sale Trade	Stockist	Importer
Power Generation / Distribution	Retail Trade	C & F Agent	Others
Works Contractor	Restaurant	Govt. Company

11.

(a) Principal Commodities in which the business deals in and

(b) The items codes therein

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.

State: whether your accounts are computerized :

Yes / No (please tick)

16.

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.

17.

A copy of the partnership deed and Memorandum of Articles of Association is enclosed.

18.

The details of additional place(s) of business/units/branches are attached as Annexure-II.

19.

The details of security furnished are attached as Annexure-III.

20.

The details of closing stock as on Appointed Day are attached in JVAT 114.

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 _________

Name________

Status________

Name _________

Status _________

Name________

Status________

Name _________

Status _________

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 Jharkhand Value Added Tax Act, 2005 and the Jharkhand Value Added Tax Rules, 2006.

(ii) A signboard 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.

	Signature ................................
Place :	Status ................................
Date:	Full Name ..............................

(Signature of other partners in case of partnership business)

(1)

(2)

	Signature ........................
Place :	Status ..............................
Date:	Full Name .......................

	Signature ........................
Place :	Status ..............................
Date:	Full Name .......................

(3)

(4)

	Signature ........................
Place :	Status ..............................
Date:	Full Name .......................

	Signature ........................
Place :	Status ..............................
Date:	Full Name .......................

______________________________________________________________________________________________

(For office use only)

Acknowledgements receipt No. ............................ Date .............................. Circle ..............................

	Signature and Stamp of Authorised Person

_____________________________________________________________________________________________

Annexure I

(To be attached with Form JVAT 100/101/102/103)*

[See Rule 3(i), 3(v), and 3(x)(a), 4(i) and 11(2)]

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 ____________
		City _________________	District ____________
		State ________________	Pin_____________________

7. Details of all immovable properties owned:

Sr. No.

Full address where property is situated

Approximate value

Extent of share

8. Particulars of other business(s) in which the person has interest

Sr.No.

Name of business

Address

Extent of share

VERIFICATION

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

* Strike out which are not applicable

Annexure- II

(To be attached with Form JVAT 100/101/103)*

[See Rule 3(i), 3(v), and 3(x)(a) & 4(i)]

Details of Additional places of business/units/branches

Serial No.

Complete Address

Use of premises-factory/ godown/ office/ sale outlet/ any other (to be specified)

Telephone Number

VERIFICATION

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.

Place____________	Signature __________________
Date____________	Full name__________________
	Status_____________________

* Strike out which are not applicable

Annexure -III

(To be attached with Form JVAT 100/101/103)*

[See Rule 3(i), 3(v), and 3(x)(a) & 4(i)]

(Details of Security Furnished)

Serial No.

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)

VERIFICATION

Place____________	Signature __________________
Date____________	Full name__________________
	Status_____________________

* Strike out which are not applicable