MADHYA PRADESH VALUE ADDED TAX RULES, 2006 - FORMS
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Body

FORM 6-A

[See rule 11-B]

Application for grant of Enrolment Certificate under Section 9-B of
the Madhya Pradesh VAT Act, 2002

To,

The ...................(designation)

..........................Circle

I request to grant enrollment and issue an enrolment certificate for my firm/organisation named..........................................as builder under Section 9-B of the Madhya Pradesh VAT Act, 2002. The particulars of my firm/organisation are given below :

Part A : Basic Information

1. Name and Full address of firm/organisation	Shop No: Village/Mohallah : District : Phone No. : (O) Mobile No. : Email :	Street/Complex : Town/City : Ward No. : (R) Fax No. : Website/URL :
2. Occupancy Status	Owned/Rented/Leased/Rent-free/Govt. land/Others (Lease Deed Registry No./Date ...................... Registrar Office Name ....................................
3. Full address of principal place of business of the firm/organisation (Attach xerox of rental/lease agreement)	Shop No. : Village/Mohallah : District : Phone No. : (O) Mobile No. : Email :	Street/Complex : Town/City : Ward No. : (R) Fax No. : Website/URL :
4. Occupancy Status	Owned/Rented/Leased/Rent-free/Govt. land/Others (Lease Deed Registry No./Date ...................... Registrar Office Name ....................................
5. Status of business (mention code only)*
6. Full Name of applicant
7. Father's name of applicant
8. Full address of the applicant	Local Address Shop No : Street/Mohallah : Town/City : District : Ward No. : Phone No : (O) (R) Mobile No.: Fax No. : Email : Website/URL :	Permanent address Shop No : Street/Mohallah : Town/City : District : Ward No. : Phone No : (O) (R) Mobile No.: Fax No. : Email : Website/URL :
9. Nature of business	construction of buildings for sale or lease
10. Date of commencement of Business
11. Date of first sale*/lease
12. Total receipts till the date of application
13. Date on which receipts of sale/lease exceed liability limit
14. If sale/lease not commenced then probable date of commencement of sale/lease
15. Goods required for consumption in construction of buildings for sale or lease
16. PAN of firm	............................................................
17. Language in which account books are written :	............................................................
18. Are account books Computerised	Yes / No
19. Have you applied for Profession Tax	Yes / No
20. Have you Produced Security	Yes / No / Not Applicable
21. Capital Investment	Rs.
22. Source of Investment	.......................................
23.Payment of Registration Fee of Rs. 500/-	Challan Number :	Date :

Part B: Details of Proprietor/Partners/Directors/Coparceners of the firm/organisation

Name and father's name	Status (*Proprietor/Partners/ directors ........)	Age	Local address with telephone No.	Permanent address with telephone No.	Extent of interest
(1)	(2)	(3)	(4)	(5)	(6)

PAN (if any)	Passport Number	Driving licence No.	Voter ID No.	Adhar No.	Signature	Signature, name and address of the person verifying the signature in column (12)
(7)	(8)	(9)	(10)	(11)	(12)	(13)

Part C : Attested Photographs of Proprietor/Partners/Directors/ Coparceners of the firm/organisation

Part D : Details of Additional Places of Business

Within Madhya Pradesh

Outside of Madhya Pradesh

Part E: Details of Bank Accounts

Account Number

Type of Account

Name of the Bank and full address of the branch

Part F: Details of Registration/licence with other departments

Name of Department/Act

Registration/License number and Date

Part G: Details of property and interest in some other business inside State

Name of proprietor/ partners/ other persons	Details of property owned with complete address and value	Registry No./ Date	Registry Office (Address)	Details of other business with TIN, if any, and extent of share in it

Part H: Details of property and interest in some other business outside State

Name of proprietor/ partners/ other persons	Details of property owned with complete address and value	Registry No./ Date	Registry Office (Address)	Details of other business with TIN, if any, and extent of share in it

Part I: Person authorised to sign on application/communication with Department of Commercial Tax

Name of Authorized person with father's name, address and Telephone number (if any)	Status in the firm	Specimen signature

Declaration

I ............................................ (Name) being ............................ of the above business firm do hereby declare that the information and particulars given above in this application are true and correct to the best of my knowledge and belief.

Place ..................

Date ..................

Signature of the builder

Part J: Verification by 2 already registered / enrolled persons

(1) I.................................S/o..............................being authorized signatory of M/s .................................. holding TIN.....................do hereby declare that I know the applicant(s) of this application form personally and I believe that particulars given in this application form are true and correct.

Place ..................

Date ..................

Signature

(2) I.................................S/o..............................being authorized signatory of M/s .................................. holding TIN.....................do hereby declare that I know the applicant(s) of this application form personally and I believe that particulars given in this application form are true and correct.

Place ..................

Date ..................

Signature

Acknowledgement

Received an application in Form 6-A for grant of registration certificate under Section 9-B of the Madhya Pradesh VAT Act, 2002 along with an affidavit and an copy of challan no. ......................... dated ........................... for Rs. .................. in proof of payment of registration fee from Shri .......................

Seal

Place ..................

Date ..................

Signature of Receiving Official

Employee ID :.......................

Code for Box 5

Firm/organisation	Code
Proprietorship	P
Partnership	R
Private Limited	L
Limited Company	A
Public Sector	T
H.U.F.	H
Co-operative Society	C
State Government Department	S
State Government Undertaking	SU
Central Government Department	G
Central Government Undertaking	U
Others	O

Check List of Enclosures :

	Registration Fee Challan.
	Affidavit in support of application.
	Xerox of partnership Deed/memorandum of association/registration with Department of Company Affairs/registration under Co-operative Societies Act.
	Photographs of all co-applicants.
	Verification of 2 TIN holding persons.
	Xerox of Rental/lease agreement of the place of business.
	Xerox of Licence/registration Certificates with other Department.