FORM G1

FORM G1
(See Rule 30A of A.P.G.S.T. Rules, 1957)
Application for Registration as Manufacturer under Section 5B of the A.P.G.S.T.Act.

The Assessing Officer,

________________________(Place)

I ____________________________________________ on behalf of _________________________ (hereby state the name and style of the manufacturing concern), resident at ______________________________________ (place) in the district of ________________________ hereby apply for a certificate of registration as manufacturer under Section 5B of the Andhra Pradesh General Sales Tax Act, 1957.

The particulars of the business are given below.

1.     Name and full postal address of the principal       :
place of business with particulars of building,
name, number, ward name, road Name, street
name etc.

2. Name and full postal address of the factory, :
place of the Manufacturing concern.

3. Registration certificate No. Under A.P.G.S.T. Act. :

4. Registration certificate No. Under the C.S.T. Act. :

5. Particulars of other Licenses/Registration
certificates issued by

        1.Industrial License No. issued by Govt. of India
                                                OR
        2.D.G.T.D. Registration Number

        3.Permanent Small Scale Industries Registration
         No. issued by Industries Department by               :
            General Manager, (Copy of certificate enclosed)

6 I propose to purchase on and from District Industries Centre, the following raw materials, component parts, sub-assembly parts, intermediate parts, (packing material and any other goods notified by Government under clause (b) of Section 5-B (i) for use in the manufacture or processing of any goods.)

        1.Description of goods proposed to be manufactured.
              Code No. of the Commodity.
         2.Description of raw material component parts, sub-assembly Parts, intermediate parts, (packing material and any
             other Goods notified by Government under clause (b) of Section 5B(1)

(a) Raw Materials

Sl. No.	Description of goods.	Code No.	Sl. No.	Description of goods.	Code No.
1.			6
2.			7
3.			8
4.			9
5.			10

(b) Component parts, sub-assembly parts, intermediate parts.

Sl. No.	Description of goods.	Code No.	Sl. No.	Description of goods.	Code No.
1.			6
2.			7
3.			8
4.			9
5.			10

Sl. No.	Description of goods.	Code No.	Sl. No.	Description of goods.	Code No.
1.			6
2.			7
3.			8
4.			9
5.			10

(d) Other goods notified by Government.

Sl. No.	Description of goods.	Code No.	Sl. No.	Description of goods.	Code No.
1.			6
2.			7
3.			8
4.			9
5.			10

I shall intimate addition or deletion, if any, to the assessing authority before purchase of the materials mentioned above at the concessional rate of tax.

I shall abide by such rules and conditions as may be prescribed from time to time. I,_____________________________________________________________________________________Son/Daughter/Wife
of_______________________________________________________________________hereby declare that to the best of my
knowledge and belief the information in this application given above is true and correct.

Date : Name :

Signature and status of the person signing the application