FORM
I
[See Rule 3(1)]
Application for
Registration
To
The
Professional Tax Officer,
__________________________________
__________________________________
__________________________________
I
hereby apply a certificate of Registration under the above mentioned Act as per
particulars given below:
(PLEASE
TYPE OR USE BLOCK LETTERS ONLY)
Name
of the Applicant
:
Address
:
Building Street Road
:
Municipal Ward
:
Town / City
:
Mandal
:
District
:
Pin Code
:
Status
of person signing this form
:
Put
(x) mark below the heading whichever is applicable.
|
Proprietor |
Partner |
Principal
Officers |
Agent |
Manager |
Director |
Secretary |
|
|
|
|
|
|
|
|
Class
of Employer
Put
(x) mark below the heading whichever is applicable
|
Individual
|
Firm |
Company |
Corporation |
Society |
Club |
Association |
| |
|
|
|
|
|
|
If
registered under the APGST Act, 1957/Central Sales Tax Act, 1959 the number of
registration Certificate held:-
A.P.G.S.T.
R.C. No :
C.S.T.
R.C. No.
:
Names
and addresses of other places of work, if any, in Andhra Pradesh
|
Sl.No |
Name |
Address |
|
1. |
|
|
|
2. |
|
|
|
3. |
|
|
|
4. |
|
|
The
above statements are true to the best of my knowledge and belief.
Date_____________
Signature________________________Status__________________________
(For
Office use only)
Registration
Certificate No.
Signature
of the Officer
Issuing the certificate.
Acknowledgement
(Particulars
of name and address to be filled in by the applicant)
Received
an application for registration in Form I :
Name
of the Applicant
:
Full
Postal Address
:
Date:
Receiving Officer’s Signature