FORM   I[See  Rule 3(1)]Application for Registration

ToThe 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.

Class of Employer

Put (x) mark below the heading whichever is applicable

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

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