VAT Acknowledgement Number : 99953548522

Acknowledgement Date : 20/12/2017

JAIPR Digitally signed by JAIPRAKASH
DN: c=IN, o=Personal,

AKAS
postalCode=302019, st=Rajasthan,
Form VAT-01 2.5.4.20=d0d4af8300261054e2c6c0d2
b1f6195bd65428b1b5ccdb82b49db59
6ae3d2ad4,
serialNumber=62fee9db8e5a130372e
[See Rule 12 (2)] 7276625093d6d1b76148ad745afdb04

H
bd0ff016e2095c, cn=JAIPRAKASH
Date: 2017.12.20 17:25:30 +05'30'

Application for e-Registration

1. Name of Dealer Mahakal Kisan Seva Kendra Manakpur

Whether Dealer is Resident / Non Resident Resident

2.Address of Principal Place of Business

Bldg. No. / Name 164/708 Area Manakpur, Mundwa Tehsil

Town / City Nagaur District (State) Nagaur

Pin Code 341028 Email Id jatinagarwal4u@gmail.com

Telephone Number 9782303084 FAX No. Not Applicable

3. Permanent Account Number (PAN) AOSPJ5948Q

4. Date of commencement of VAT 18/12/2017

business
ET Not Applicable

LT Not Applicable

ENT Not Applicable

5. Date from which liable to VAT 18/12/2017

be registered
ET Not Applicable

LT Not Applicable

ENT Not Applicable

6. Actual value of goods purchased,stock receipt of goods in Not Applicable

the year upto teh date of submission of the application (in
Rs.)

7. Type of Dealer Intends to sale goods other than those mentioned

8. Nature of Business :

Sr No. Business Type If Manufacturer (As defined by sub

section(1) of section 7 of the Micro,
Small and Medium Enterprises
Development Act , 2006 )

1 Retailer Not Applicable

2 Wholesaler Not Applicable

9. Commodities dealt with/ proposed to be dealt with

Intend to Purchase Intend to Sale

1. High And Light Speed Diesel Oil 1. High And Light Speed Diesel Oil
2. Petrol 2. Petrol

10. Constitution of Business : Proprietorship

11. Particulars of the proprietor / partners / directors / Karta /Trustees / Members of the governing body / authorized
signatory :

Particulars :

Full Name JAIPRAKASH Father's / Husband's Name RAMESH CHAND

Date of Birth 28/03/1992 Status Sole Proprietor

Extent of interest PAN AOSPJ5948Q

Details of all immovable

property

Permanent Address

RADHA VIHAR, NEW SANGANER

Room No. PLOT NO. 22 S-1 Area
ROAD

Town/City JAIPUR District JAIPUR

State Rajasthan Pin Code 302019

Mobile No. 9782303084 Alternate Phone

Fax Email ID jatinagarwal4u@gmail.com

XI Particulars of interest in any other business (es), if any.

XII Particulars of interest in any other closed business (es)

12. Details of surety / security bond:

A. In case of surety

Name of Business of Surety TIN

Not Applicable
B. In case of security is furnished by cash /NSC, detail thereof

Sr. No. Security Type Name of Bank Receipt No. Amount Date of Security Date of Maturity

1 Cash Deposit Electronic Payment 0006326027917201 10000 20/12/2017 Not Applicable

22017

C. In case of security is furnished by Bank Guarantee, details thereof

Amount Of Bank Effective Period Of Effective Period Of Name of Bank Branch Address
Guarantee Bank Guarantee From Bank Guarantee To
Date Date

Not Applicable

13. Information regarding Bank :

Name of Bank Branch Address Account No. Bank IFSC Code

State Bank Of India Degana 61115639942 SBIN0031117

14 - 15. Details of Branch(es)/ Additional Place(s) of business including warehouse(s)in the State:

Sr. No. Name of Type of Bldg. No. Area Town / District State Pin Code Telephon FAX No. Email ID
the Business / Name City e Number
Business
Not Available
16. Details of Business Manager:

Name of Business Manager Jaiprakash

Address

Room No. Plot No. 22 S-1 Area Radha Vihar New Snaganer Road

Town/City Jaipur District Jaipur

State Rajasthan Pin Code 302019

Telephone No. Not Applicable Email ID jatinagarwal4u@gmail.com

Fax Not Applicable

Signature of Applicant
Date of PDF Generation : 20/12/2017