FORM
D
Application
for Registration as a Dealer under Section 12 of The Andhra
Pradesh General Sales Tax Act, 1957
(See Rules 28 and 29 of
A.P.G.S.T. Rules, 1957)
To
The
Assistant / Deputy Commercial Tax Officer,
Division
______________________________
Circle
______________________________
Unit
______________________________
I______________________________________________________________________(Name of the applicant) carrying on the proprietor business known as____________________________________
___________________________________________________________(Name of Proprietary) here by apply for registering me under Section 12 of the Andhra Pradesh General Sales Tax Act, 1957.
OR
I______________________________________________________________________(Name of the applicant) the________________________________________________**(Status of applicant in the firm) of the____________________________________________***(Status of firm) Carrying on the business known as _________________________________________________________________ (Name of the business) hereby apply for registering, the said________________________________ ***(Status of firm) under Section 12 of the Andhra Pradesh General Sales Tax Act, 1957.
**
Status of applicant in firm may be
1.
Partner
2. Managing Director
3. Secretary
4.
Principal Officer 5.
Trustee
6. Any other status
*** Status of firm may be
1. Partnership
2. Private Ltd.,
3. Public Ltd.,
4. Society
5. Trust
6. Club
7. Association
8. Govt. Company 9.
Hindu Undivided Family
10. Works Contract
11. Hotels
The
particulars of the above business are given below.
1.
Name and full postal address of the principal place of business with the
particulars of building, name and number, ward name and number, street name
etc.,
Name
_________________________
Address
__________________________
Building
Name _________________________
Building Number____________________________
Ward
Name _________________________
Ward Number ______________________________
Street
/ Road _________________________
Village
/ Town _________________________
STATE____________________________________
District
_________________________
Pin code___________________________________
2.
Name and full postal address of all the other places of business in the
state with particulars of building, name and number, ward name and number, road
name, street etc., of each place of business (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 _________________________
STATE____________________________________
District
_________________________ Pin
code___________________________________
Page
number(s) of additional sheet(s)
used______________________________________________
3.
(a) Name and full address of
all the other places of business outside the state with full details as required
under Column 2. (Attach additional sheets if required).
Name
_________________________
Address
_________________________
Building
Name _________________________
Building Number ____________________________
Ward Name _________________________
Ward Number ______________________________
Street
/ Road _________________________
Village
/ Town _________________________
STATE____________________________________
District
_________________________ Pin
code___________________________________
Page
number(s) of additional sheet(s)
used______________________________________________
(b)
Name and full address of registered office of business, is situated outside the
state of A.P. along with Registration Certificate number.
Registration Certificate No
___________________________________________________________
Name
_________________________
Address
_________________________
Building
Name _________________________
Building Number ____________________________
Ward
Name _________________________
Ward Number ______________________________
Street
/ Road _________________________
Village
/ Town _________________________
STATE____________________________________
District
_________________________ Pin
code___________________________________
Page number(s) of additional sheet(s)
used______________________________________________
4.
Complete list of godowns in which the goods relating to the business are
stored and address of every such godown (Attach additional sheets in the given
format, if required)
Name
_________________________
Address
_________________________
Building
Name _________________________
Building Number ____________________________
Ward
Name _________________________
Ward Number ______________________________
Street
/ Road _________________________
Village
/ Town _________________________
STATE____________________________________
District
_________________________ Pin
code___________________________________
Page number(s) of additional sheet(s)
used______________________________________________
5.
Description of all classes of goods either bought, sold, manufactured,
supplied, distributed etc., by the dealer (Attach additional sheets if required)
|
|
Commodity
Description |
Code
|
|
Commodity
Description |
Code |
|
1 |
|
|
6 |
|
|
|
2 |
|
|
7 |
|
|
|
3 |
|
|
8 |
|
|
|
4 |
|
|
9 |
|
|
|
5 |
|
|
10 |
|
|
Page
number(s) of additional sheet(s)
used______________________________________________
6.
Date of Commencement of business Date ______ Month ___________________
Year ________
7.
The language in which the Accounts are Kept and
maintained____________________________
8.
The accounting year followed by the dealer for the purpose of Income Tax
Act.
From __________________ To _________________
9.
Name(s) and addresses of the proprietors, partners, all persons having
any interest in the business (Additional sheet with the following columns shall
be used, if necessary).
Page number(s) of additional sheet(s) used
___________________________________________
(a)
Serial number _____________________________________________________________
(b)
Name in full of the person
_____________________________________________________
(c)
Name of father of the person
___________________________________________________
(d)
Age of the person ___________________________________________________________
(e)
Permanent postal address of the person
_________________________________________
__________________________________________
__________________________________________
__________________________________________
(f)
Present postal address of the person
__________________________________________
__________________________________________
__________________________________________
__________________________________________
(g)
Extent of interest of the person in the
Business
__________________________________________
(h)
Signature of the person
_________________________________________
(i)
Name, address and signature of witness attesting signature and
identifying the persons (The identification should be by 2 dealers who are
registered under the Act).
a)
Partners names & signatures
|
S.No. |
Name |
Signature |
S.No. |
Name |
Signature |
|
1 |
|
|
6 |
|
|
|
2 |
|
|
7 |
|
|
|
3 |
|
|
8 |
|
|
|
4 |
|
|
9 |
|
|
|
5 |
|
|
10 |
|
|
Witness
(Registered dealer)
|
S.No. |
Name
and Address |
R.C.Number |
Signature |
|
|
1. |
|
|
|
|
|
2. |
|
|
|
|
10.
Particulars of other interests, if any, in other business concerns or
other concerns, such as shares and stocks, investment in chit funds, securities,
defence certificates, National Savings Certificates, Central and State loans
including those floated by Public Undertakings, deposits including Bank accounts
and movable and immovable operaties of the properties, partners, members in the
business, both in State and in other States (Please append a list containing
these particulars, in respect of each member).
Page
number(s) of additional sheet(s) used __________________________________________
11.
Particulars of registration certificate if any, held by the dealer,
before the submission of this application under the General Sales Tax Act, with
the name of the office from where the certificate has been obtained with number
and date of certificate.
Division
__________________________________________
Circle
__________________________________________
Unit
__________________________________________
No.
__________________________________________
Date
:
__________________________________________
12.
Particulars of Central Sales Tax Registration Certificate, if any, held
by the dealer with the name of the office, where such certificate has been
obtained with number and date of certificate.
Division
__________________________________________
Circle
__________________________________________
Unit
__________________________________________
No.
__________________________________________
Date
__________________________________________
13.
General nature of business: (Tick whichever is applicable)
1.
Wholesale
2. Retail
3.
Manufacturing
4. Agency
5.
Distribution
6. Stockist
7. Leasing Company
8. Hotel
9.
Works Contract
10. If any other, specify
14.
Details of goods ordinarily purchased by the dealer for (Attach
additional sheets if required)
(a)
Use as raw materials in the manufacture of goods for sale
|
|
Commodity
Description |
Code |
|
Commodity
Description |
Code |
|
1 |
|
|
3 |
|
|
|
2 |
|
|
4 |
|
|
Page
number(s) of additional sheet(s) used
______________________________________________
(b)
Sale in the course of inter-State trade or commerce.
|
|
Commodity
Description |
Code |
|
Commodity
Description |
Code |
|
1 |
|
|
3 |
|
|
|
2 |
|
|
4 |
|
|
Page
number(s) of additional sheet(s)
used______________________________________________
(c)
Export outside the State
|
|
Commodity
Description |
Code |
|
Commodity
Description |
Code |
|
1 |
|
|
3 |
|
|
|
2 |
|
|
4 |
|
|
Page
number(s) of additional sheet(s)
used______________________________________________
(d)
Despatch outside the State
|
|
Commodity
Description |
Code |
|
Commodity
Description |
Code |
|
1 |
|