MADHYA PRADESH VALUE ADDED TAX RULES, 2006 - FORMS
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FORM 6

{See rule 11(1)}

Application for grant of Registration Certificate under section 17 of the Madhya Pradesh Vat Act, 2002

To,

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

....... Circle

FOR OFFICE USE

TIN Allotted

I request to grant registration and issue a registration certificate for my firm/organization named ..................... ..............................................

under 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:
Street Complex:
Village/Mohlla:	Town/City
District:	Ward No.
Phone No: (O)	(R)
Mobile No.	Fax No.
Email
Web Site/URL:

2. Occupancy Status

Owned/Rented/Leased/Rent-free/Govt. Land/Others

(Leased 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:
Street Complex:
Village/Mohlla:	Town/City
District:	Ward No.
Phone No: (O)	(R)
Mobile No.	Fax No.
Email
Web Site/URL:

4. Occupancy Status

Owned/Rented/Leased/Rent-free/Govt. Land/Others

(Leased 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

Permanent address

Shop No:

Street Complex:

Village/Mohlla:

Town/City

District:

Ward No.

Phone No: (O)

(R)

Mobile No.

Fax No.

Web Site/URL:

Shop No:

Street Complex:

Village/Mohlla:

Town/City

District:

Ward No.

Phone No: (O)

(R)

Mobile No.

Fax No.

Web Site/URL:

9 Nature of business (mention code only)**

10 Date of commencement of Business

11. Date of First Sale

12. Total Sales till the date of application

13. Date on which sales exceeds liability limit

14. If sales not commenced then probable date of commencement of sale

15. Description of goods

S No.	Commodity	Commodity (HSN) Code	Standard Industry Code	% of revenue

(a) Trading mainly in

(b) Manufacturing mainly of

(d) works contractor

16. Goods required,-

(a) for use or consumption in manufacturing or processing or mining of goods for sale

........................................................................................

(b) for use in packing of goods for sale

........................................................................................

17 PAN of firm

........................................................................................

18 Language in which account books are written

........................................................................................

19 Are account books Computerised

YES / NO

20 Status of Central sales Tax registration (Please tick)

(.) 7(1) (.) 7(2) ( ) Not appled

21. Have you appled for Professional Tax

22. Have you produced Security

YES/ NO / NOT APPLICABLE

23. Capital Investment

Rs.

24. Source of Investment

........................................................................................

25. Payment of Registration Fee of Rs. 500/-

Challan Number:

DATE:

PART B: Details of Proprietor/ Partners/ directors/ co-parceners of the firm/organisation

Name and father's name	Status (*Proprietor/ Partners/ directors....)	Age	Local address	Permanent address	Extent of interest	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).
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10)	(11)	(12)	(13)

PART C: Attested Photographs of Proprietor/Partners/Directors/Co-parceners of the firm/ organisation

PART D: Details of Additional Places of Business

With in Madhya Pradesh	Outside of Madhya Pradesh
1.	1.
2.	2.
3.	3.

PART E: Details of Manufacturing units of the business

With in Madhya Pradesh	Outside of Madhya Pradesh
1.	1.
2.	2.
3.	3.

PART F: Details of godowns / warehouses

With in Madhya Pradesh	Outside of Madhya Pradesh
1.	1.
2.	2.
3.	3.

PART G: Details of Bank Accounts

Account Number	Type of Account	Name of the Bank and full address of the branch
1.
2.
3.

PART H: Details of Registration / licence with other departments

Name of Department / Act	Registration/ License number and Date
1. Shop and establishment Act
2. Essential commodity Act
3. Krishi Upaj Mandi
4. Commerce and industries department
5.
6.

PART I: Details of property and interest in some other business

Name of proprietor/partners/other persons	Details of property owned with complete address and value	Details of other business with TIN and extent of share in it	Registry No. /Date	Registry Office (Address)
1.
2.

PART J: Person authorized 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 dealer

PART K: Verification by 2 already registered Dealer

(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)

Place....

Date:

Signature

Acknowledgement

Received an application in form 6 for grant of registration certificate under section 17 of the Madhya Pradesh Vat Act, 2002 along with an affidavit and a 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: .....

Notes

'Code for box 3		** Code for box 9
Firm/ organization	Code	Nature of business	Code
Proprietorship	P	Agent	1
Partnership	R	Manufacturing/ Processing	2
Pvt. Ltd.	L	Importer	3
Limited Company	A	Leasing	4
Public Sector	T	Mining	5
H.U.F.	H	Government and local authority	6
Co- operative society	C	Works Contractor	7
State Government Department	S	Retailer	8
State Government Undertaking	SU	Mulitple Activities	9
Central Government Department	G	Distributor C & F Agent/Stockist	10
Central Government Undertaking	U	Wholesales/Stockist	11
Others	O	CSD canteen	12
		Exporter	13
		Any other - should be specified	14

Check List of Enclosures:

Registration Fee Challan.

Affidavit in support of application.

Xerox of partnership Deed/ memorandum of association/ registration with department of company affaires/ registration under co-operative society Act / registration with works department.

Photographs of all co-applicants.

Verification of 2 TIN holding dealers.

Xerox of Rental/ lease agreement of the place of business.

Xerox of Rental/ lease agreement of godowns / warehouse.

Xerox of Licence/ registration Certificates with other Department.

Security Proof

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