The Gujarat Value Added Tax Rules, 2006
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FORM 101C

(Appended to Form 101)

(See sub-rule (1) of rule 14)

SPECIMEN SIGNATURE OF AUTHORISED PERSON AS PER SECTION 66A

(1) I, Shri/Srimati/Kumari _______________ Proprietor of M/s ____________________ bearing TIN ____________

(2) I/We Shri/Srimati/Kumari ________________________________ Partners of M/s ________________ bearing TIN ________________

(3) I/We Shri/Srimati/Kumari ________________________________ Directors/Managing Director of M/s ___________________ bearing TIN ________________ (Strike out from (1) to (3) whichever is not applicable)

do hereby authorize Shri/Srimati/Kumari _______________________________ under Section 66A who is/are working as partner/managing director/director/manager or _________________ in our firm.

Details of persons so authorized under Section 66 A

1.	Full Name
2.	Father's/Husband's Name
3.	Date of Birth
4.	Extent of interest in business (Partnership firm)/ Official Designation and date of joining in the present capacity (in case of Directors in Limited Companies)/Status & function of Person Responsible (Authorised) for the business.
5.	Present Residential Address : Telephone No : e-mail :
6.	Permanent Address : Telephone No.

The specimen signature of the person so authorized is/are as under :

Name of person authorized

Status

Specimen signature

I/We hereby state that the person above named has signed in our presence and I/We hereby attest the signature as true and valid signature for the purpose of Gujarat Value Added Tax Act, 2003 and Gujarat Value Added Tax Rules, 2006.

Date:

Signature & Status.

Note : (Separate form should be filled in for each person)