1. | (a) Name of applicant cccccccccc (b) Address of the applicant cccccccccccccccccccc cccccccccccccccccccc cccccccccccccccccccc |
2. | Details of Permanent Account Number (PAN) of the applicant (a) Whether PAN has been issued by the Income Tax Department cc Yes No (b) If Yes, the PAN cccccccccc (c) Name of the applicant (as appearing in PAN) cccccccccc |
3. | (a) Constitution of applicant (Tick as applicable) (i) Proprietorship c (ii) Partnership c (iii) Registered Public Limited Company c (iv) Registered Private Limited Company c (v) Registered Trust c (vi) Society/Cooperative society c (vii) Others c (b) Name, Address and Phone Number of Proprietor/Partner/Director (i) Name cccccccccc (ii) Address cccccccccccccccccccc cccccccccccccccccccc cccccccccccccccccccc (iii) Phone Number cccccccccc |
4. | Category of Registrant (Please tick appropriate box) (a) Person liable to pay service tax (i) Service provider c (ii) Service recipientc (b) Other person/class of persons (i) Input service distributorc (ii) Any provider of taxable service whose aggregate value of taxable service in a financial year exceeds three lakh rupees c |
5. | (a) Nature of Registration (Tick as applicable) (i) Registration of a single premise c (ii) Centralized Registration for more than one premises c (b) Address of Premises for which Registration is sought (i) Name of Premises / Building cccccccccccccccccccc (ii) Flat/Door/Block No. cccccccccccccccccccc (iii) Road/Street/Lane cccccccccccccccccccc (iv) Village / Area / Lane cccccccccccccccccccc (v) Block/Taluk/Sub-Division/Town cccccccccccccccccccc (vi) Post office cccccccccccccccccccc (vii) City/District cccccccccccccccccccc (viii)State/Union Territory cccccccccccccccccccc (ix) PIN cccccccccccccccccccc (x) Telephone Nos.: cccccccccccccccccccc (xi) Fax No. cccccccccccccccccccc (xii)E-mail Address cccccccccccccccccccc (c) In case of application for Centralized Registration, furnish address of all the premises from where taxable services are provided or intended to be provided (FORMAT AS PER 5(b) ABOVE) (d) In case of application for Input Service Distributor, furnish address of all the premises to which credit of input services is distributed or intended to be distributed (FORMAT AS PER 5(b) ABOVE) |
6. | Address of the premises or office paying service tax under centralised billing or centralised accounting under sub-rule (2) and (3A) of rule 4 of the Service Tax Rules, 1994. Address cccccccccccccccccccc cccccccccccccccccccc cccccccccccccccccccc |
7. | Description of taxable services provided or to be provided by applicant |
S.No. | Description of service | Relevant clause of section 65 of the Finance Act, 1994, to be indicated, if possible |
(1) | (2) | (3) |
(Signature of the applicant/authorized person with stamp)
Date:Signature of the Officer of Central Excise
(with Name & Official Seal)
1. | PAN No. cccccccccc |
2. | Service Tax Code ccccccccccccccc (Registration Number) |
3. | Taxable Services ccccccccccccccc |
4. | Address of business premises: (i) Name of Premises / Building cccccccccccccccccccc (ii) Flat/Door/Block No. cccccccccccccccccccc (iii) Road/Street/Lane cccccccccccccccccccc (iv) Village / Area / Lane cccccccccccccccccccc (v) Block/Taluk/Sub-Division/Town cccccccccccccccccccc (vi) Post office cccccccccccccccccccc (vii)City/District cccccccccccccccccccc (viii)State/Union Territory cccccccccccccccccccc (ix) PIN Telephone Nos: cccccc cccccccccccccc (x) E-mail Address cccccccccccccccccccc |
5. | PREMISES CODE ccccccccc [SL.NOS.2,3,4 TO BE REPEATED FOR EVERY PREMISES BEING GRANTED A REGISTRATION UNDER THIS CERTIFICATE. PREMISES CODE IS GIVEN BY THE DEPARTMENT BASED ON THE COMMISSIONERATE+DIVISION+ RANGE+ SL NO] |
Place: . | Name and signature of the Central Excise |
Date: . | Officer with official seal |
1. | Name of the assessee ccccccccccccccc |
2. | Registration Numbers of premises for which return is being filed ccccccccccccccc |
3. | Category of taxable services for which return is being filed: (Mention all the taxable services provided/received) (1)________________________________ (2)________________________________ (3)________________________________ |
4. | Payment of Service Tax Category of Service: __________________________________________________ |
Apr/Oct | May/Nov | June/Dec | July/Jan | Aug/Feb | Sept/Mar | Total of column (2) to | |
(1) | (2) | (3) | (4) | (5) | (6) | (7) | (8) |
Amount received towards taxable service(s) provided | |||||||
Amount received in advance towards taxable service(s) to be provided | |||||||
Amount Billed- gross | |||||||
Amount billed for exempted services other than export | |||||||
Amount billed for exported services, without payment of tax | |||||||
Amount billed for services on which tax is to be paid | |||||||
Abatement claimed- Value | |||||||
Notification number of Abatement | |||||||
Notification number of exemption | |||||||
Provisional Assessment order no. | |||||||
Service tax payable | |||||||
Education cess payable | |||||||
Service tax paid in cash | |||||||
Challan Number | |||||||
Challan date | |||||||
Service tax paid through cenvat credit | |||||||
Education cess paid in cash | |||||||
Education cess paid through education cess credit |
Amount-Cash | Challan Number | Date | Amount-Credit | Source Document No | |
(1) | (2) | (3) | (4) | (5) | (6) |
Arrear of service tax | |||||
Education cess | |||||
Interest | Not applicable | ||||
Penalty | Not applicable | ||||
Miscellaneous | Not applicable | ||||
Excess amount paid and adjusted subsequently** | |||||
Total |
Details of Credit | Apt/Oct | May/Nov | June/Dec | July/Jan | Aug/Feb | Sept/Mar |
(1) | (2) | (3) | (4) | (5) | (6) | (7) |
Opening Balance | ||||||
Credit availed on inputs | ||||||
Credit availed on capital goods | ||||||
Credit availed on input services | ||||||
Credit received from inputs service distributor | ||||||
Total credit availed | ||||||
Credit utilized towards payment of service tax | ||||||
Closing balance |
Details of Credit | Apt/Oct | May/Nov | June/Dec | July/Jan | Aug/Feb | Sept/Mar |
(1) | (2) | (3) | (4) | (5) | (6) | (7) |
Opening Balance | ||||||
Credit of education cess availed on goods | ||||||
Credit of education cess availed on services | ||||||
Credit of education cess utilized for payment of service tax | ||||||
Closing Balance |
Details of Credit | Apt/Oct | May/Nov | June/Dec | July/Jan | Aug/Feb | Sept/Mar |
(1) | (2) | (3) | (4) | (5) | (6) | (7) |
Opening Balance | ||||||
Credit of service tax received | ||||||
Credit of service tax distributed | ||||||
Credit of service tax not eligible to be distributed* | ||||||
Closing Balance |
Details of Credit | Apt/Oct | May/Nov | June/Dec | July/Jan | Aug/Feb | Sept/Mar |
(1) | (2) | (3) | (4) | (5) | (6) | (7) |
Opening Balance | ||||||
Credit of education cess received | ||||||
Credit of education cess distributed | ||||||
Credit of education cess not eligible to be distributed* | ||||||
Closing Balance |
Place: Date: | (Name and Signature of Assessee or Authorized Signatory) |
(Signature of the Officer of Central Excise & Service Tax)
(With Name & Official Seal)
(R. Sriram)
Deputy Secretary to the Government of India
(F.No. 137/44/2004-CX.4)