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)

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

Witness (Registered dealer)

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

Page number(s) of additional sheet(s) used ______________________________________________

(b)     Sale in the course of inter-State trade or commerce.

Page number(s) of additional sheet(s) used______________________________________________

(c)     Export outside the State

Page number(s) of additional sheet(s) used______________________________________________

(d)     Despatch outside the State

Page number(s) of additional sheet(s) used______________________________________________

15.   Details of goods, if any, Imported into the State by the dealer from foreign countries or from other States in India.

Page number(s) of additional Sheet(s) used______________________________________________

16.   Name and address of the Chambers of Commerce,     

Trade Association etc., of which the dealer is a

member                                                                        :

(Attach additional sheets, if required)                                   

           
Page Number(s) of additional sheet(s) used______________________________________________

17.  The total turnover of the year preceding to
which the application is submitted.                                    :

18.   Actual turnover of the year upto date of submission
of the application                                                            :

19.   The estimated total turnover for the year in which
         application is submitted                                                :

20.   Amount of registration fee paid with particulars of  
challan number and date, cheque number and date,    
name of treasury, bank etc.                                           :

DECLARATION

I, ______________________________________________________________ son/daughter/wife of ____________________________________________________________ hereby declare that to the best of my knowledge and belief the information in this application give above is true and correct.

 
Place:                                                                                              Name, address and signature of the person
                                                                                                           signing with the status and relationship to
Date:                                                                                                 the dealer, (Here state whether proprietor,
                                                                                                             manager, director, partner etc.)

Note:

1.     On every additional sheet of paper used indicate the Registration Certificate Number with    division, Circle and Unit number.  Also indicate the serial number of the information to which it pertains.
 

2.    Write the page number of each additional sheet attached to this form starting from page       number 9.

3.     Total number of pages enclosed.   

(FOR OFFICIAL USE BY THE REGISTERING AUTHORITY)

 
1.  Date of receipt of application                                    __________________________________________

2.   Nature of order passed by the Registering
Authority in the application                                    __________________________________________

3.   Date on which, the place at which and the
officer before whom the applicant is called            Date ______________________________________
for verification of accounts.                                           Place _____________________________________

4.   The date by which the registration certificate is ready ___________________________________

5.  Registration Certificate number and date of      Division ___________________________________
      issue                                                                               Circle: ______________________________                                                                      
                                                                                                Unit Number _______________________________
                                                                                                Date  _____________________________________

6. Old number (if any in red ink)                                    Division________________________________
                                                                                                Circle_____________________________________
                                                                                                Unit Number _______________________________
                                                                                                Date______________________________________

7.  No. of branches                                                __________________________________________

8.  No. of godowns                                                __________________________________________

9.  No. of Partners                                                 __________________________________________

10.  No. of Commodities                                       __________________________________________

11.  General category of business (See list     __________________________________________

       of codes supplied)

SIGNATURE OF THE REGISTERING AUTHORITY

Name                _________________________

Address            ________________________

Building Name  _________________________             Building Number____________________________

Ward Name      _________________________              Ward Number ______________________________

Street / Road    _________________________

Village / Town   _________________________            STATE____________________________________

District              _________________________                Pin code___________________________________

Name                _________________________

Address            _________________________

Building Name  _________________________             Building Number ____________________________

Ward Name      _________________________             Ward Number ______________________________

Street / Road    _________________________

Village / Town   _________________________            STATE____________________________________

District              _________________________                  Pin code___________________________________

Name                _________________________

Address            _________________________

Building Name  _________________________            Building Number ____________________________

Ward Name      _________________________             Ward Number ______________________________

Street / Road    _________________________

Village / Town   _________________________            STATE____________________________________

District              _________________________                Pin code___________________________________

Additional Sheet for point No.14(  )