FORM - 101

(See rule 8)
Application for Registration under section 16 of The Maharashtra Value Added
Tax Act, 2002.
To
31 of Registering Authority
-Aurangabad
I hereby apply for grant of registration under section 16 of The Maharashtra Value Added Tax
Act , 2002
1. (a) Income Tax Parmanent Account Number (PAN) of business.
A J D P A 5 4 4 1 R
2. Name of the Business
A S H I S H D I S T R I B U T O R

3. Constitution
* Proprietorship Partnership Private Ltd. Co. Public Ltd. Co.
HUF Co-operative Society Trust Joint Venture

4. Name of the signatory to the application

R A M E S H W A R V I D Y A R A M A G R
A W A L

5. Status of the signatory to the application

* Proprietor Partner Karta( adult member of Director
HUF)
Manager Principal Officer Authorized person

6. Reasons for Registration [Please (*) tick the appropriate box]

(a) Voluntarily (b) Change in the constitution (c) Part transfer of business
(d) Full transfer of business * (e) Exceding the prescribed
trunover limit

6a. Voluntary registration

Introduction by a registred dealer ( should be continuously registered for 5 years)
[see rule 8(11)(c)]

(i) Name of dealer

(ii) TIN under MVAT Act,2002
Date of effect (DD/MM/YYYY)
(iii) Signature
OR
Introduction by agent duly listed under section 82 of the Act

Status of the agent

(i) Name of agent
(ii) Membership No.
(iii) Signature

6b. Change in the Constitution

(i) Change in constitution from Proprietorship
To Proprietorship
(ii) With effect from
R.C. No. (Previous)
6c. Part transfer of business
(i) Business transferred from
(ii)TIN
(iii)With effect from
6d. Full transfer of business
(i) Business transferred from ASHISH DISTRIBUTORS
(ii) With effect 2009-09-26
(iii)TIN 27980272949V

6e. Exceeding the prescribed turnover limit ( The limits should be crossed in the same
financial year )
The following are the sales and purchases effected in a financial year on the basis of which
the application for RC has been made.
Date on which turnover limits exceeded
Sales
Date of Sale. Bill No. Name and address Commodity Amount(Rs.)
of the vendor
Purchases
Date of Bill No. Name and R.C. No. Commodity Amount(Rs.)
Purchases address of the
vendor
7 . Nature of business
Trans Id : 34582 Trans Date : Nov 21, 2009 Dealer Name : RAMESHWAR VIDYARAM AGRAWAL Page No 2

Main Nature Reseller * Manufacturer Retailer Importer Exporter

Works Contractor Leasing Restaurant Commission Agent
Part Nature Reseller Manufacturer Retailer Importer Exporter
Works Contractor Leasing Restaurant Commission Agent
*

8 . Date of commencement of business

Mention the date on which business is started 2009-09-26
9 . Do you want to opt for composition scheme in lieu of Sales Tax Payable?

Yes No *
Retailer Restaurant/Caterer Bakery Second Hand Mandap Decorator
Passenger motor
vehicle Dealer

10 . Language in which books of accounts are maintained

* English Hindi Marathi Gujrathi

11 . Whether the records are computerized?(Please tick (*) the appropriate box )
Yes No Partially

12 . Full address of the principal place of business

Bldg. Name/Office No./Flat No. SHOP NO 3131
Area Name etc. NEAR BANK OF MAHARASHTRA
Street Name ete. MAINROAD
Village/town/city Sillod (M Cl)
Taluka Sillod
District Aurangabad
Pin Code 431112
Telphone No. 1 02430222006
Telphone No. 2
Mobile No. 1 9049153599
Mobile No. 2
Fax No.
Email address
Email address
13 . Occupancy status of the principal place of the business
Owned * Rented Leased Rent free

14 . Full address of the additional palaces(s) of business / Godown(s) / Warehouse(s) in

Maharashtra
Bulding Name/Office No./Flat No AMRUTA AGENCIES, SHOP NO 3131
Area name etc. MAIN ROAD
Street Name etc. NEAR BANK OF MAHARASHTRA
Village/town/city Sillod (M Cl)
Taluka Sillod
District Aurangabad
Pin Code 431112
Telphone No. 1 9049153599
15. Address(s) in other State(s) and corresponding TIN under C.S.T Act , if any
Bldg. Name/Office No./Flat No.
Area Name etc.
Street Name etc.
City
State
Pin Code
Corresponding CST RC / TIN
Telphone No
16. Details of Bank Account(s)
Name of the Bank STATE BANK OF INDIA
Branch SILLOD
Account Number 30688178691
Type of Account CURRENT
MICR No 431002518
17. Main commodities to be sold
SrNo. Name of the commodity Schedule Entry 3
SALT A48 1 CIGARETTE
D12 2 FMCG E
4 ATTA A9 5
18. Main commodities to be purchased
Trans Id : 34582 Trans Date : Nov 21, 2009 Dealer Name : RAMESHWAR VIDYARAM AGRAWAL Page No 3

SrNo. Name of the commodity Schedule Entry 5

EDIBLE OIL C30 1 CIGARETTE
D12 4 ATTA A9
2 FMCG E 3
19. A copy of my recent photograph is furnished with this application as required by sub-rule
(7)of rule 8.

Directors/Partners” replace with “Proprietor/partner/director/members of managing

committee/all persons having any interest in the business
Bulding Name/Office No./Flat No PLOT NO.108
Area Name etc.
Street Name etc. SHASTRI COLONY
Village/town/city Sillod (M Cl)
Taluka/District Sillod
District Aurangabad
PIN Code 431112
Telphone No. 9049153599
PAN No. AJDPA5441R
P.T.E.C. No.

Undertaking
I RAMESHWAR VIDYARAM AGRAWAL , Proprietor of M/s. ASHISH DISTRIBUTOR hereby affirms that
the information submitted is true to the best of my knowledge & belief.

Date : Nov 21, 2009Signature of applicantStatus & Authority thereof