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FORM VAT 250

APPLICATION OPTING FOR PAYMENT OF TAX


BY WAY OF COMPOSITION
[ see Rules 17(2)(b), 17(3)(c), 17(4)(b) & 19(5) ]

Date Month Year


01 Tax Officer Address
Commercial Tax Officer 01 11 07
Malakpet Circle
Hyderabad
02 TIN

03 Name

Address

I / we carrying on business as a Works contactor / as a hotelier do hereby apply to pay sales tax by way
of composition.

* I) At the rare of 4% on the total value of the contract executed for the Government or local Authority subject
to such conditions as may be prescribed.

* II) At the rate of 4% on 50% of the total consideration received or receivable for the contract other than state
Government and local authorities subject to such conditions as may be prescribed.

* III) At the rate of 4% on 25% of the consideration received or receivable or the market value fixed for the purpose
of stamp duty whichever is higher, for the contact of constructing and selling of residential apartments, houses
building or commercial complexes subject to such conditions as may be prescribed.

* Iv) At the rate of 12.5% on 60% of the total consideration charged for food and drink to such conditions as may
be prescribed.

The details of contracts for which composition is opted for are given below:

SL Name & Address of the Nature of Contract Date of Full value of the
NO. Contractee Contract Contract

01

(* Strike off whichever is not applicable ) Signature of the Dealer,


Stamp and seal

FORM VAT 250


APPLICATION OPTING FOR PAYMENT OF TAX
BY WAY OF COMPOSITION
[ see Rules 17(2)(b), 17(3)(c), 17(4)(b) & 19(5) ]

Date Month Year


01 Tax Officer Address
Commercial Tax Officer 01 11 07
Malakpet Circle
Hyderabad
02 TIN 2 8 4 0 0 1 4 5 4 8 7

03 Name D.Nagappa ( contractor)

Address 16-2-147/F/5, Malakpet, Hyderabad-36

I / we carrying on business as a Works contactor / as a hotelier do hereby apply to pay sales tax by way
of composition.

* I) At the rare of 4% on the total value of the contract executed for the Government or local Authority subject
to such conditions as may be prescribed.

* II) At the rate of 4% on 50% of the total consideration received or receivable for the contract other than state
Government and local authorities subject to such conditions as may be prescribed.

* III) At the rate of 4% on 25% of the consideration received or receivable or the market value fixed for the purpose
of stamp duty whichever is higher, for the contact of constructing and selling of residential apartments, houses
building or commercial complexes subject to such conditions as may be prescribed.

* Iv) At the rate of 12.5% on 60% of the total consideration charged for food and drink to such conditions as may
be prescribed.

The details of contracts for which composition is opted for are given below:

SL Name & Address of the Nature of Contract Date of Full value of the
NO. Contractee Contract Contract

01 Superintending Engineer(II) Civil Contract 10/29/2007 Rs. 10,70,000/-


Greater Hyderabad, MCH
6th Floor, C.C Complex,
Tank Bund Road,
Hyderabad-63

Work order No
224/ SE-II / GHMC / T5 /
2007-2008/2576

(* Strike off whichever is not applicable ) Signature of the Dealer,


Stamp and seal

FORM VAT 250


APPLICATION OPTING FOR PAYMENT OF TAX
BY WAY OF COMPOSITION
[ see Rules 17(2)(b), 17(3)(c), 17(4)(b) & 19(5) ]

Date Month Year


01 Tax Officer Address
Commercial Tax Officer

02 TIN

03 Name

Address

I / we carrying on business as a Works contactor / as a hotelier do hereby apply to pay sales tax by way
of composition.

* I) At the rare of 4% on the total value of the contract executed for the Government or local Authority subject
to such conditions as may be prescribed.

* II) At the rate of 4% on 50% of the total consideration received or receivable for the contract other than state
Government and local authorities subject to such conditions as may be prescribed.

* III) At the rate of 4% on 25% of the consideration received or receivable or the market value fixed for the purpose
of stamp duty whichever is higher, for the contact of constructing and selling of residential apartments, houses
building or commercial complexes subject to such conditions as may be prescribed.

* Iv) At the rate of 12.5% on 60% of the total consideration charged for food and drink to such conditions as may
be prescribed.

The details of contracts for which composition is opted for are given below:

SL Name & Address of the Nature of Contract Date of Full value of the
NO. Contractee Contract Contract

(* Strike off whichever is not applicable ) Signature of the Dealer,


Stamp and seal
FORM VAT 213
APPLICATION FOR UNDER / OVER DECLARATION OF VALUE ADDED TAX
[ See Rule 23(6) (a) ]

Date Month Year


01 Tax Office Address:-
10 09 07

02 TIN

03 Name

Address:-

Examination of my records has shown that the correct amount of Value Added Tax in the return for tax period

01-05-2007 was * under declared / over- declared. Please find a true and correct summary of my monthly

Return as below. The errors were caused by

Tax Input Output Input tax Output tax Tax under / Total Amount
period Tax Tax found to found to over-declared payable /
declared declared be correct be correct Creditable

5/1/2007 89602 93781 90307 94486 0 0


to
5/31/2007

I ( Name) E. Ramesh

being ( Title ) Proprietor of the above business

do hereby declare that the information given on this form is true and correct.

Signature / Stamp Date of Declaration 9/10/2007

PLEASE DO NOT ADJUST ANY FURTHER RETURN FOR THE TAX SHOWN ON THIS FORM.

Complete in Duplicate

* Strike off which ever is not applicable Signature & Status


FORM 560
NOMINATION OF RESPONSIBLE PERSON
[ see Rule 63(1) & (3) ]

DECLARATION NOTIFYING PERSONS AUTHORISED TO SING ANY RETURN /


DOCUMENT / STATEMENTS AND TO RECEIVE NOTICES, ORDERS, ETC.,
UNDER THE ANDHRA PRADESH VALUE ADDED TAX ACT 2005

TO

Name : Date Month Year

Address : 25 01 2008

TIN / GRN

I / we Mr. Sunkara Chandra Sekhar, Director of TYCHE MARKETING PVT LTD

being proprietor / Managing partner / Managing Director etc., do hereby authorise the

following person(s) to sign any return / documents / statements / and to receive notices

orders etc., under the Andhra Pradesh Value Added Tax Act, 2005.

Sl. Name of the person Status and relationship Specimen signature


no. of the person to the dealer of the person
named in col.(2)

{1) { 2} {3} {4}

Signature of the Dealer(s) / Athorised signatory

I / we accept the above responsibility.

Signature of the person(s) authorised


FORM VAT 100
APPLICATION FOR VAT REGISTRATION Affix a passport size
[ See Rule 4(1) ] photo of sole Propreitor.
In case of Partnership
Submit in duplicate firms/Companies/others
Affix photos of
Use separate sheet where space is not sufficient responsible persons on
VAT 100B.
To
The Commercial Tax Officer,
VAT Registering Authority,
LORDBAZAAR Circle.

01. Name of the Business


to be registered :

02. Address of Place of business:

Door No. Street


Locality, District
Town/ City Pin Code
Phone No. Fax No
E-Mail Website URL

03. Occupancy Status : Owned Rented X Leased Rent-free Others

04. Name & Address of the Owner of business :( Residential Address of the person responsible ie., Managing partner /
Managing Director for business ).

Name
Date of Birth
Door No., Street
Locality District
Town / City Pin Code
Phone No. Fax No
E-Mail

05. Status of business : ( Mark "√ " where applicable )

Sole Proprietorship Partnership Private Limitede Company X

Public Limited Company Govt, Enterpise Others ( Specify )

06. Nature of Prinicipal business activties TRADING

07 Prinicipal Commoditied traded Napkins


Baby Diapers

08. Bank Account Details


Bank Name Branch & Code Account No
1
2
3
09 Income Tax Permanent Account Number : (PAN )

10. Address of additional places of business/ Branches/


Godowns ( Including those outside A.P).Use Form VAT 100A NO

11 Particulars of owner / partners / Directors etc., Yes


Use Form VAT 100B
12 Language in which books are written English

13 Are your accounts computerized Yes NO x

Date Month Year


14 Date of First taxable sale
15 Turnovers of taxable sales of goods including
zero rate in
a) The last 3 months Rs --
b) The last 12 months Rs
16 Anticipated turnovers of taxable sales of goods
including zero rate in
a) The next 3 months Rs
b) The next 12 months Rs
17 Anticipated Turnover of exempted sales of
goods and transactions in the next 12 months --

18 Are you applying for voluntary registration Yes x NO

19 Are you applying for registration as start


up Business Yes NO x

20 Indicate your GRN Number, if any


Have you appliced for CST Registration Yes x NO

21 Registration Number ( if any under No


Profession Taxc Act )

22 Do you expect your input tax to regulary Yes NO x


exceed your outpu tax ?
if yes Why?

23 Are you applying for registration in response to Yes NO x


a notice by the Tax Officer ?
If yes, indicate the Notice number --

24 Any other relevant information like are you --


availing Tax incentives? If so write details

DECLARATION
S/o

Status Director
the above enterprise hereby declare that the particulars given are correct and true to the best of my Knowledge and belief.
I under take to notify immediately to the registering authority in the Commercial Taxes Department of change in ay of the
above particulars

Date of application Signature with stamp

FOR OFFICE USE ONLY

25 Date of receipt of application

26 Activity / Commodity Code


27 Exempt Indicator

28 Voluntary Registration Indicator

29 Startup Business Indicator

30 CST Indicator

31 Refund Indicator

32 Works Contract Indicator

33 Suo motu Registration Indicator

34 Special Rates- Schedule-VI goods Indicator

35 Tax Incentives Indicator

36 Date of issue of Registration Certificate

37 Effective date of Registration

38 Date of refusal of Registration

39 Tax payer Identification Number (TIN)

PROCESSING AUTHORITY REGISTERING AUTHORITY

NAME NAME

DESIGNATION DESIGNATION

FORM VAT 100A


DETAILS OF ADDITIONAL PLACES OF
BUSINESS / BRANCHES / GODOWNS IN ANDHRA PRADESH

NAME OF THE BUSINESS :

01 Address

Pin Code NO Telephone No


Signature Date

02 Address

Pin Code NO Telephone No

Signature Date

03 Address

Pin Code NO Telephone No

Signature Date

04 Address

Pin Code NO Telephone No

Signature Date

05 Address

Pin Code NO Telephone No

Signature Date

ADDRESSESS OF BRANCHES / GODOWNS LOCATED


OUTSIDE ANDHRA PRADESH

01 State
Address

PIN Code No Telephone No

R.C. Number under state Act:


R.C. Number under C.S.T Act:

Signature Date
02 State
Address

PIN Code No Telephone No

R.C. Number under state Act:


R.C. Number under C.S.T Act:

Signature Date

03 State
Address

PIN Code No Telephone No

R.C. Number under state Act:


R.C. Number under C.S.T Act:

Signature Date

04 State
Address

PIN Code No Telephone No

R.C. Number under state Act:


R.C. Number under C.S.T Act:

Signature Date

FORM VAT 100B


PARTICULARS OF PARTNERS / DIRECTORS / PERSONS
RESPONSIBLE (AUTHORISED) FOR THE BUSINESS
Affix a passport
size photo
NAME OF THE BUSINESS : of Partner /
Director /
1. Fill in the details for each Partner / Director / Responsible Person Separately in the Person
boxes provided for. Please Use BLOCK LETTERS and write clearly. Responsible
2. Strike off partners / Director / Responsible Persons whichever is not applicable
PARTNERS / DIRECTORS / PERSONS RESPONSIBLE DETAILS
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 )
of the business.
05 Other business interests in the state ( Please specify )
06 Other business interests outside the state( Please specify)
07 Present Residential Address:

Telephone
E-Mail
08 Permanent Address
Telephone
09 Income Tax Permanent Account Number (PAN)

Date
Signature & Status

Affix a passport
size photo of
Partner /
Director / Person
Responsible

PARTNERS / DIRECTORS / PERSONS RESPONSIBLE DETAILS

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 )
of the business.
05 Other business interests in the state ( Please specify )
06 Other business interests outside the state( Please specify)
07 Present Residential Address:

Telephone
E-Mail
08 Permanent Address
Telephone
09 Income Tax Permanent Account Number (PAN)

Date
Signature & Status

Affix a passport
size photo of
Partner /
Director / Person
Responsible

PARTNERS / DIRECTORS / PERSONS RESPONSIBLE DETAILS

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 )
of the business.
05 Other business interests in the state ( Please specify )
06 Other business interests outside the state( Please specify)
07 Present Residential Address:
Telephone
E-Mail
08 Permanent Address
Telephone
09 Income Tax Permanent Account Number (PAN)

Date
Signature & Status
FORM - A
Application for Registration as a Dealer Under Section 7(1) / 7(2)
of the Central Sales Tax Act, 1956
( See Rule 3)

To

The Assistant / Deputy Commercial Tax Officer

DIV Cir Unit

S/o

( Name of applicant ) ( Name of Father )

on behalf of the dealer carrying on the business know as

( Name of buisness ) ** ( Style / Nature of business )

within the state of ANDHRA PRADESH hereby apply for a certificate of registration under section 7(1) / 7(2) of the
Central Sales Tax Act, 1956 and give following particulars for this purpose.

1 Name of the person deemed to be the manager in relation to the business of the dealer in the said state

2 Status of the applicant 1. Manager 2. Partner 3. Proprietor


( Tick whichever is applicable ) 4. Director 5. Officer-in-charge of the Government business

3 Name and full postal address of the principal place of business in the said state:

Name

Address

Building Name Building Number

Ward Name Ward Number

Street / Road

Village / Town

District STATE

Pincode

** Nature of business may be--


1 Partnership 4 Govt Company 7 works contract 10 Hotels
2 public Ltd 5 Society 8 Hindu undivided family11 Club
3 Private Ltd 6 Association 9 Trust

2
4 Name(s) and address(es) of the other places of business in the said state. ( if the space in this column is found to be
insufficient, additional sheets, may be used and duly signed.)

Name
Address

Building Name Building Number


Ward Name Ward Number
Street / Road
Village / Town
District STATE
Pincode

Page number(s) of additional sheet(s) used:

5 Complete list of godowns in which the goods relating to the business are stored and address of every such godown
( Attach additional sheet if required ).

Name
Address

Building Name Building Number


Ward Name Ward Number
Street / Road
Village / Town
District STATE
Pincode

Page number(s) of additional sheet(s) used:

6 Name(s) and address(es) of the other places of business in each of the other states( Attach additional sheets, if required).

Name
Address

Building Name Building Number


Ward Name Ward Number
Street / Road
Village / Town
District STATE
Pincode

Page number(s) of additional sheet(s) used:

7 The business is

Wholly
Mainly
Partly
Specify whether business is wholly agriculture, mining, manufacturing, leasing, wholesale distribution, retail
distribution, contracting or catering etc., or any combination of two or more of them.
8 Particulars relating to registration, licence, permission etc., issued under any law for the time being in force, of the dealer

DIV CIR UNIT NUMBER

APGST

9 Name and address of the Chamber of Commerce, Trade Association or Commercial body of which the dealer is a member

Name:
Address:

10 The Language in which the accounts are English


Kept and maintained

11 Name(s) and address(es) of the proprietor, partners, members, all persons having any interest in the business
( Additional sheets with the following columns shall be used, for each partner / Director if necessary ).

a) Serial Number

b) Name in full of each person

c) Name of father of each person

d) Age of each person

e) Extent of interest of each person


in the business

f) Present address of each person

g) Permanent address of each person

h) Signature of each person

i) Name, address and signature of witness attesting signature and identifying the proprietor / partners at SL.NO. 11(h)

Partners
SL.NO Name Signature
1 2 3
1
2

Attestation by witness ( Registrered dealer )

Name Address R.C Number Signature


1 2 3 4
DD MM YY
12 Date of Commencement of business

DD MM YY
13 The first sale in the course of inter-state trade was effected on

From To
14 The accounting year followed by the dealer for the purposes
of Income Tax Act
( State month or festival )

15 We make up our accounts of sales at the end of ( Tick 1. Everymonth 2. quarter


whichever is applicabe). 3. Half year 4. Year

16 Details of goods ordinarily purchased by the dealer in interstate trade: ( Attach additional sheets if required )

a) For resale

Commodity description Code Commodity description Code

1 3

2 4

Page number(s) of additional sheet(s) used

b) Use in Manufacture of goods or processing of goods for sale

Commodity description Code Commodity description Code

1 3

2 4

Page number(s) of additional sheet(s) used

c) Use in the mining /use in the generation or distribution of electricity / use in packing of goods for
sale / resale ( Tick whichever is applicable ).

Commodity description Code Commodity description Code

1 3

2 4

Page number(s) of additional sheet(s) used

17 Name of goods manufactured by the dealer-- (Attach additional sheets if required )


Commodity description Code Commodity description Code

1 3

2 4

Page number(s) of additional sheet(s) used

DECLARATION

I, son / daughter/
wife of declare that to
the best of my. Knowledge and belief, the information in this application given above is true and correct.

Place
Date HYDERABAD Name, address and signature of the person signing with
the status and relationship to the dealer.

( Here state whether Manager, partner, proprietor, Director,


Officer-in-charge of the Government business)

6
( FOR OFFICIAL USE BY THE REGISTERING AUTHORITY)

1 Date of receipt of application

2 Nature of order passed by the Registering


Authority in the application

DIV CIR UNIT NUMBER


3 Registration Certificate number and date
of issue ( APGST)

Date

DD MM YY

DIV CIR UNIT NUMBER


4 Registration certificate number
and date of issue (CST)

Date

DD MM YY

5 No. of branches
6 No. of godowns

7 No. of partners

8 No.of commodities

9 Old R.C No APGST

10 Old R.C No CST

SINGATURE OF THE REGISTERING AUTHORITY

Note: 1 On every additional sheet of paper used, indicate the Registration Certificate number with division,
circle and unit number.Also indicate the serial number of the information to which it pertains.

2 Write the page number of each, additional sheet attached to this form starting from page number 7

3. Total number of pages enclosed

11 Name(s) and address(es) of the proprietor, partners, members, all persons having any interest in the business
( Additional sheets with the following columns shall be used, for each partner / Director if necessary ).

a) Serial Number

b) Name in full of each person

c) Name of father of each person

d) Age of each person

e) Extent of interest of each person


in the business

f) Present address of each person

g) Permanent address of each person

h) Signature of each person


12 Name(s) and address(es) of the proprietor, partners, members, all persons having any interest in the business
( Additional sheets with the following columns shall be used, for each partner / Director if necessary ).

a) Serial Number

b) Name in full of each person

c) Name of father of each person

d) Age of each person

e) Extent of interest of each person


in the business

f) Present address of each person

g) Permanent address of each person

h) Signature of each person


FORM 565
FORM OF AUTHORISATION
[ See Rule 65(7) ]

AUTHORISATION TO BE FILED BY A PERSON APPEARING BEFORE ANY


AUTHORITY BEHALF OF A DEALER UNDER SECTION 66 OF THE
ANDHRA PRADESH VALUE ADDED TAX ACT 2005

To

Name
Date Month Year
Address
2008

TIN / GRN

I / we hereby

appoint sri who is my relative /a

person regularly employed by me / the said*

/ a legal practitioner/a Chartered Accountant/a Sales Tax Practitioner to attend on my behalf / behalf of

the said* / before

( State the Tax Authority ) the proceedings ( describe the proceedings)

before the said ( state the Tax Authority )

and to produce accounts and documents / statements and to receive on my behalf / behalf of the said**

any notice or documents/ statements issued

in connection with the said proceedings . Sri

is here by authorised to act on my behalf / behalf of the said*

in the said proceedings.

I agree / the said* agrees to ratify all acts done

by the said sri in pursuance of this authorisation.

Signature(s) of the Authorizing person(s)

I/ we accept the above responsibility

*/** Delete as appropriate


Signature(s) of Authorised person(s)
FORM TOT 001 Affix a passport size photo
APPLICATION FOR TOT REGISTRATION
of sole Propreitor.
In case of Partnership
[ See Rule 4(2) ] firms/Companies/others
Affix photos of responsible
persons on 001B.
Submit in duplicate
Use separate sheet where space is not sufficient

To
The Commercial Tax Officer,
VAT Registering Authority,
Circle.

01. Name of the dealer :


APGST NO. if any :

02. Address of Place of business:

Door No. Street


Locality, District
Town/ City Pin Code
Phone No. Fax No
E-Mail Website URL

03. Occupancy Status : Owned Rented X Leased Rent-free Others

04. Status of business : ( Mark "√ " where applicable )

Sole Proprietorship X Partnership Private Limitede Company

Public Limited Company Govt, Enterpise Others ( Specify )

05. Name & Address of the Owner of business :( Residential Address of the person responsible ie., Managing partner /
Managing Director for business ).

Name
Date of Birth
Door No., Street
Locality District
Town / City Pin Code
Phone No. Fax No
E-Mail

06. Nature of Prinicipal business activties

07 Prinicipal Commoditied traded

08. Bank Account Details


Bank Name Branch & Code Account No
1
2
3
09 Income Tax Permanent Account Number : (PAN )

10. Address of additional places of business/ Branches/


Godowns ( Including those outside A.P).Use Form 001A NIL
11 Particulars of owner / partners / Directors etc., ENCLOSED
Use Form 001B
12 Taxable Turnover of your business for the last 12 0
consecutive months

13 Estimated taxable turnover of your business for next


12 consecutive months

14 Date on which taxable turnover for 12 consective months NA


exceeded Rs. 5 lakhs
15 Registration Number
( if any under Professional Tax Act )

DECLARATION
W/o

Status
the above enterprise hereby declare that the particulars given are correct and true to the best of my Knowledge and belief.
I under take to notify immediately to the registering authority in the Commercial Taxes Department of change in ay of the
above particulars

Date of application Signature with stamp

FOR OFFICE USE ONLY

16 Date of receipt of application

17 Effective date of registration

18 Date of certificate by Registering Authority

19 Date of refusal of registration by Registering Authority

20 GENERAL REGISTRATION NUMBER

FORM TOT 001A


ADDRESSES OF ADDITIONAL PLACES OF
BUSINESS / BRANCHES / GODOWNS IN ANDHRA PRADESH

NAME OF THE BUSINESS :

1 Fill in the addresses of Additional Places of Business/ Branches/Godowns in the spaces provided for.
2 Strike off additional Places of Business/Branches/Godowns whichever is not applicable

ADDITIONAL PLACE OF BUSINESS/ BRANCH/GODOWN

01 Address

Pin Code NO Telephone No

Signature Date

ADDITIONAL PLACE OF BUSINESS/ BRANCH/GODOWN

02 Address

Pin Code NO Telephone No

Signature Date

ADDITIONAL PLACE OF BUSINESS/ BRANCH/GODOWN

03 Address

Pin Code NO Telephone No

Signature Date

ADDITIONAL PLACE OF BUSINESS/ BRANCH/GODOWN

04 Address

Pin Code NO Telephone No

Signature Date

ADDITIONAL PLACE OF BUSINESS/ BRANCH/GODOWN

05 Address

Pin Code NO Telephone No

Signature Date
ADDITIONAL PLACE OF BUSINESS/ BRANCH/GODOWN

06 Address

Pin Code NO Telephone No

Signature Date

ADDITIONAL PLACE OF BUSINESS/ BRANCH/GODOWN

06 Address

Pin Code NO Telephone No

Signature Date

ADDITIONAL PLACE OF BUSINESS/ BRANCH/GODOWN

07 Address

Pin Code NO Telephone No

Signature Date

FORM TOT 001B


PARTICULARS OF PARTNERS / DIRECTORS / PERSONS
RESPONSIBLE (AUTHORISED) FOR THE BUSINESS Affix a passport
size photo of
NAME OF THE BUSINESS : Partner /
Director / Person
1. Fill in the details for each Partner / Director / Responsible Person Separately in the Responsible
boxes provided for. Please Use BLOCK LETTERS and write clearly.
2. Strike off partners / Director / Responsible Persons whichever is not applicable

PARTNERS / DIRECTORS / PERSONS RESPONSIBLE DETAILS


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 )
of the business.
05 Other business interests in the state ( Please specify )
06 Other business interests outside the state( Please specify)
07 Present Residential Address:

Telephone
E-Mail
08 Permanent Address
Telephone
09 Income Tax Permanent Account Number (PAN)

Date
Signature & Status

Affix a passport size


photo of Partner /
Director / Person
Responsible

PARTNERS / DIRECTORS / PERSONS RESPONSIBLE DETAILS

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 )
of the business.
05 Other business interests in the state ( Please specify )
06 Other business interests outside the state( Please specify)
07 Present Residential Address:

Telephone
E-Mail
08 Permanent Address
Telephone
09 Income Tax Permanent Account Number (PAN)

Date
Signature & Status