FORM IVA
[See Rule 9B(1)]
Application for Grant of Licence for payment of Tax under Section 15A of the Act

 

To

The Entertainments Tax Officer

___________________________

___________________________

_____________________

 

Sir,

I/We apply for grant of licence to pay tax on entertainment provided through Cable T.V.. Network under the Andhra Pradesh Entertainments Tax Act, 1939.  I furnish below the necessary particulars:

 

1.       Name of the proprietor/Managing Partner and his residential address.  
   ____________________________________________________________________
   ____________________________________________________________________
   ____________________________________________________________________

2.       Name(s) and address(es) of the proprietor, partners, members, all persons having any interest in the cable services.

 

(1)     S.No.   

(2)     Name in full of each person

(3)     Name of father of each person

(4)     Age of each person

(5)     Permanent address of each person

 

 

 

(6)     Present postal address of each person

 

 

 

 

(7)     Extent of interest of each person

 

(8)     Signature of the person

 

3.       Residential Address:

   ________________________________________________________________

   ________________________________________________________________

   ________________________________________________________________

 

4.       Place and address from where Cable T.V. Network services are provided.

   ________________________________________________________________

   ________________________________________________________________

   ________________________________________________________________

 

5.       Nature of equipment installed for Cable T.V. services

   ______________________________________________________________

   ______________________________________________________________
  
   ______________________________________________________________

 

6.       Peripherals limits of area covered/proposed to be covered for cable services.

   _______________________________________________________________

   _______________________________________________________________

 

7.       No. of  connections provided (A separate statement giving names and addresses of subscribers to be  
   furnished):________________________________________________________________

 

8.       Amount of subscription fee charged per month per connection: ___________________________

 

9.       Amount of tax payable per connection: ______________________________________________

 

 

I hereby undertake to furnish true and correct returns required to be filed by me under the Act in such  
form and at such time as may be stipulated. 

I agree to pay the taxes due in respect of the entertainment along with the returns as per the  
provisions of Act, and rules.

I agree to and undertake to abide by all the conditions of the licence.

 

                                                                                                Signature of Proprietor/  
                                                                                                                 Managing Partner

DECLARATION

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

Place       :  

Date         :                                                                                                                                     Signature of Proprietor