Application for Certificate of Enrolment/Revision of Certificate of Enrolment
under the Andhra Pradesh Tax on Professions
, Trades, Callings and
Employments Act
, 1987
(See Rules 4(1) and 6(2))



The Professional Tax Officer,

I hereby apply for a certificate of enrolment / revision of certificate of enrolment under the above mentioned Act as per particulars given below:


1.       Name of the applicant                 :


2.       Full Postal Address                              :




3.       Date of birth and Age                  :


4.     Profession, Trade or Calling                    :


5.     Period of standing in profession
in years and months                               :


6.       Numbers of other places of works            :

      (Please give the address of the places)




7.       Annual turnover of all sales / purchases      :


*8.  Number of workers engaged in the factory      :


*9.  Number of employees in the establishment   :


*10. If Co-operative Society whether State Level :

       District Level or Mandal Level


*11.  Number of Vehicles for which permit under   

        M.V. Act is held                                         :

                     2 Wheelers                                   :         

                     Trucks and                                   :          

                     Buses                                             :

                     Total                                               :          


*12.  Enrolment No. of previous certificate,
         if any                                                                :


*13   If registered under APGST Act 1957/
        CST Act, 1956 the No. of registration
        Certificates held                                                  :


             APGST Act, 1957                                              :
             CST Act, 1956                                                   :


*14. Grounds on which revision is sought              :
       (attach additional sheets if necessary)

The above statements are true to the best of my knowledge and belief.


 Dated :                                                                                                                                       Signature with status.

*Please fill up whichever is applicable.


For office Use Only


Enrolment  No.                                                  :

Date of Enrolment                                             :

                                                                                                                                                               Signature of Issuing Officer

(Particulars of name and address to be filled by applicant)

Received an application for enrolment in Form


 Name    :                                                                      

 Address:                                                                    Application No:

                                                                                      Dated          :
Signature of Receiving Officer,