APPLICATION FOR REGISTRATION UNDER SECTION 69 OF THE FINANCE
ACT, 1994 (32 OF 1994)
1. Name of the assessee
2. Address of the assessee
3. Address of the premises to be registered
4. Category of the service
5. Fax/Telex and Phone Number
6. Form of organisation (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 the 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 thereunder.
9. I/We …………….. declare to the best of my/our
knowledge and belief that the information furnished herein
is true and complete.
Signature of assessee or his authorised representative