Form A : Application for Registration as dealer
| Updated at | December 2009 |
FORM A
[See rule 4(9)]
APPLICATION FOR REGISTRATION AS DEALER
To
The Registering Authority ____________________ Circle _____________________
1.NAME OF THE BUSINESS *
2. Address : *
Building Name Door
No.
Street / Road Village / Town /
City *
PIN *
a. Principal place
of business *
b. Branch
c. Factory
d. Godown
3.Address of the Head Office outside the State
4Constitution * Proprietor 5. Business
Transaction Customs Registration BIN
(√ tick) Partnership Industry Regn. No. / SSI No.
Private Limited Company Central Excise Regn. No.
Public Limited Company Registrar of Company's CIN
HUF Property Tax Assessment no., if any
Co-operative Society Income Tax PAN
Government Undertaking Director General of Foreign Trade's
Import / Export Code
Others
Bank and Account no.
6. Date of commencement of business : *
7.Details of the Proprietor / Partners / Directors, etc.:*
Name Age Name of Father /
Husband
Status Present
Address
Permanent
address
Extent of share
or interest in
business
1
2
3
4
5
6
7
PHOTO
/ /
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