[Application form for registration under Section 69 of the Finance Act, 1994 (32 of 1994)]

(Please tick appropriate box below)

c New Registration
c Amendments to information declared by the existing Registrant.
Registration Number in case of existing Registrant seeking Amendment
_____________

(Above table has been substituted vide NTF. NO. 48/2012-ST, DT. 30/11/2012)

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8. Name, Designation and Address of the Authorized Signatory /Signatories:
 

I, ___________________________________________hereby declare that the information given in this application form is true, correct and complete in every respect and that I am authorized to sign on behalf of the Registrant.

(a) For new Registration:
I would like to receive the Registration Certificate by mail / by hand/ E-MAIL

(b) For amendments to information pertaining to existing Registrant:
Date from which amendments are made: _______________
(Self certified photocopy of Registration Certificate is required to be enclosed)

(In Declaration, the brackets and words "(Self certified photocopy of Registration Certificate is required to be enclosed)" has been subsituted vide NTF. NO. 01/2007-ST, DT. 01/03/2007)

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(Original existing Registration Certificate is required to be enclosed)]
 

(Signature of the applicant/authorized person with stamp)

Date:
Place:
 

(To be given in the event Registration Certificate is not issued at the time of receipt of application for Registration)

I hereby acknowledge the receipt of your Application Form
 

(a) For new Registration
(As desired, the New Registration Certificate will be sent by E-MAIL/ mail/handed over to you in person on______________)

(b) For amendments to information in existing Registration

[Omitted -
(I hereby acknowledge receipt of original existing Registration Certificate) ]

(In Acknowledgement, the brackets and words "(I hereby acknowledge receipt of original existing Registration Certificate)" has been omitted vide NTF. NO. 01/2007-ST, DT. 01/03/2007)
 

Signature of the Officer of Central Excise
(with Name & Official Seal)

Date:

(Above annexure has been inserted vide NTF. NO. 48/2012-ST, DT. 30/11/2012)

(Form ST - 1 has been substituted vide NTF. NO. 31/2005-ST, DT. 20/10/2005)
 

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	1.	Name of the assessee				:

	2.	Address of the assessee				:

	2A.	PAN Number					:

	(Above sr. no. (2A) has been inserted vide Ntf. No. 5/2001-ST, dt. 9/7/2001)

	3.	Address of the premises to be registered		:

	4.	Category of the service				:

	5.	Fax / telex and phone number			:

	6.	Form of organization (individual /company /		:
		partnership, etc.)

	7.	Additional information required in the			:
		case of stock-broker


		(a)	Name of the member, with code No.			:

		(b)	Name of stock exchange registered with		:

		(c)	Date of admission of membership			:

		(d)	Whether member of more than one stock exchange?	:
			If so, please give name of the stock exchange 
			with code number
 
		(e)	Registration number allotted by Securities and		:
			Exchange Board of India (copy of certificate of 
			registration may be enclosed or a copy of application 
			for registration with SEBI may be enclosed) 


	8.	I/ We _________________________ agree to abide by all the provisions of Service Tax Rules,
		1994, and any order issued there under. 

	9.	I/ We ________________declare to the best of my / our knowledge and belief that the
		information furnished herein is true and complete. 


Place :
Date : 

					Signature of assessee or his authorized representative]

(Note:- see
1. Trade Notice No. 6/97-ST, dt. 1/7/97
2. Trade Notice No. 7/97-ST, dt. 4/7/97
3. Trade Notice No. 53/97-ST, dt. 4/7/97
4. Trade Notice No. 62/97-ST, dt. 5/8/97
5. Trade Notice No. 71/97-ST, dt. 29/8/97)