Form VAT-01(A)

(See rule 12 (k))

(To be attached with Form VAT-01)

Information about Proprietor, each partner (in case of partnership) Director (in case of
Private Company) separately and Karta of HUF.

1.

Name

______________________________________

2.

Fathers Name

______________________________________

3.

Status

______________________________________

4.

Extent of interest in business _____________________________________

5.

Permanent Address
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------

6.

Present Address
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------

7.
Details of all immovable properties owned:
S.No. Full address where property
Approximate
is situated
value

Extent of
Share

8.
Particulars of other business(s) in which the person has interest
S.No. Name of business
Address
Extent of
Share

Verification
The above details are true and correct to the best of my knowledge and belief
and nothing has been concealed therein.
Place ____________________
Date ___________________

Signature of the person

concerned