Application for Amendment(s) in Particulars subsequent to Registration under Delhi Value Added Tax Act, 2004

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....in only those following fields that are to be amended. All other fields should be left blank or struck out) 1. Full Name of Applicant Dealer 2. Nature of Business (Tick all applicable)Manu- facturer Trader Lea- singWorks Contra -ctor Expor- Impor- Others ter ter (specify) 3. Constitution ofProprie- torship Private Ltd. Company Public Sector Undertaking Business (Tick& one asapplicable) Partnership Government Government Corporation Company HUF Public Ltd. Company Govt Deptt/ Society/ Club/ Trust Others, pleasespecify Works Contra -ctor Expor- Impor- Others ter ter (specify) 4. Principal Place of BusinessBuilding Name/ Number Area/ Road Locality/ Market Pin Code Email Id Telephone Number Fax Number 5. Address for service of notice (If....

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....arta/ partners/ directors in the business / Members of Executive Committee of societies, clubs etc.] having interest in the business Nature of change (tick as applicable) Deletion Amendment Addition Date of change (mm/dd/yyyy) / / • In case of amendments of existing particulars, please fill in Fields 1 & 2 and thereafter only those fields that are to be amended. All other fields should be left blank or struck out. • In case of deletion of a person, please fill in Fields 1 & 2 only • In case of addition of a new person, please complete the Form in full 1. Full Name of Applicant Dealer Registration No./TIN 2. Full Name of Person (Provide in order of first name, middle name, surname) 3. Date of birth 4. Gen....

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....yyy)// AddressBuilding Name/ Number Area/ Road Locality/ Market Distt. State Pin Code Email Id Telephone Number Fax Number Date of establishment// State local sales tax/VAT/CSTDayMonthYear registration number (if place of business is situated outside Delhi) Type Godown / Warehouse FactoryShopOtherplace of business Nature of change (tick as applicable)ClosureAdditionAmendment Date of change (mm/dd/yyyy)// AddressBuilding Name/ Number Area/ Road Locality/ Market Distt. State Pin Code Email Id Telephone Number Fax Number Date of establishment// State local sales tax/VAT/CST registration number (if place of business is situated outside Delhi) Day Month Type Godown / Warehouse FactoryShopOtherplaceof business Nature of change (tick as appli....

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.... out) • (In case of deletion of a person, please fill in fields 1 & 2 only) • (In case of addition of a new person, please complete the Form in full) 1. Full Name of Applicant Dealer Registration No./TIN 2. Name of Authorised Signatory (Provide in order of first name, middle name, surname) 3. Date of birth one) Female Male 4. Gender (tick 5. Father's / Husband's name First Name Middle Name Surname 6. PAN : 7. Passport No. 8. E-mail address 9. Residential Address (If different from principal place of business)Building Name/ Number Area/ Road Locality/ Market Distt. State Pin Code Telephone Number Fax Number 10. Permanent Address Building Name/ Number Area/ Road Locality/ Market Distt. State (If from diff....

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....bill should be in the name of the business and for the address specified as the main place of business in the registration form)5,000 C. Total Reductions Allowed (Total of B1 to B6 as applicable, subject to maximum of Rs.50,000) D. Security to be furnished (A-C) E. Security already furnished and valid as on date F. Additional security (if any) to be furnished (D-E) G. Additional Security (a) Amount of Security Rs. (b) Type of Security (c) Date of expiry of Security / Month / Year Day Verification I/We hereby solemnly affirm and declare that the information given hereinabove is true and correct to the best of my/our knowledge and belief and nothing has been concealed therefrom. Signature of Authorised Signatory Full Name (first name....