FORM - I
(See rule 3(1))
EMPLOYERS REGISTRATION FORM
Application for Registration under sub-section (1) of section 5 of The Maharashtra State
Tax on Professions, Trades, Callings and Employments Act, 1975
To,
The Registering Authority
I hereby apply for grant of registration certificate under section 5 of The Maharashtra State Tax
on Professions, Trades, Callings and Employments Act, 1975.
1. PAN / TAN of Employer * AGXPR0376F
Name of the Employer (as mentioned
2. Shri SANTOSH BHARGAV RAHATE
in PAN/TAN)*
3. Constitution * Proprietorship
4. Nature of Work/Business/Activity (Mention appropriate Sr. No. from Annexure- II) *
i). Serial No. (2)Reseller (includes Wholesalers)
ii). In case of Serial Number-44,
Status of the Signatory to the
5. PROPRIETOR
application *
Documents to be attached: Letter of Authorization where the signatory is
the Authorised Person of a Proprietor, Corporate Body and Union/State
Government.
5(A) Name of the signatory to the application
First Name Middle Name Surname
SANTOSH BHARGAV RAHATE
Date of commencement of activity of
6. 24-05-2006
Employer *
Commencement of liability, Month
7. from which the liability to pay tax
commences * [MMYYYY]
Mention the date on which liability to pay
tax commences 04-2023
8. No. of employees on the date of application to whom salary or wages paid per month are *
Salary/Wages No of employees
a) Do not exceed rupees 7,500/- 1
b) Exceed rupees 7500/- but do not exceed rupees 10,000/- (M) 0
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c) Exceed rupees 7500/- but do not exceed rupees 10,000/- (F) 0
d) Exceed rupees 10,000/- 0
Total 1
9. Full Address of the Principal Place of Employer *
Address
Building No/Flat No/Door No 4/92 Floor No FLOOR 4
Name of the Premises/ NOORBANU Road/Street/Lane VISHNU GANESH PINGLE MARG
Building MANSION
District Mumbai * Taluka/Area MUMBAI (M. CORP)
Locality/Post/Village Parel Pin Code 400012
Latitude Longitude
Contact Details
Telephone No.1 with
9819241354 FAX Number
STD Code
Telephone No.2 with
STD Code
Mobile No.1 * 8779492810
Mobile No. 2
Email Address 1 * [email protected]
Website
Nature of Possession of
Leased
Premises
Electricity Bill Details :
Service Provider Name ----- Select -----
Consumer No.
Account No.
Billing Unit ---SELECT---
IGR Details:
District
Location of Sub-registrar
Year 0000
Document Number
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10. Details of Bank Account(s) *
Total number of Bank Accounts maintained by the applicant for conducting business 1
Select_Entry Bank Code Type ifsc
Accout Number 113202000000824
Type Of Account CURRENT
MICR_Code
IFSC_Code IOBA0001132
Name of bank INDIAN OVERSEAS BANK
Branch & Address of Bank PALI HILL
PIN Code : STATE : Maharashtra
11. Full address of the Additional place(s) of Employer
Building No/Flat No/Door No Floor No
Name of the Premises/ Road/Street/Lane
Building
District Taluka/Area
Locality/Post/Village Pin Code
Latitude Longitude
Contact Details
Telephone No.1 with
FAX Number
STD Code
Telephone No.2 with
STD Code
Mobile No.1 * 8779492810
Mobile No. 2
Email Address 1 *
Email Address 2
Website
Nature of Possession of
Premises
Electricity Bill Details :
Service Provider Name
Consumer No.
Account No.
Billing Unit ---SELECT---
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IGR Details:
District 000
Location of Sub-registrar
Year 0000
Document Number
Employer Member ID or PF Account
12. Number *
13. Other information (If applicable)
TIN under MVAT Act, 2002
1
Date of effect (DD/MM/YYYY)
TIN under CST Act, 1956
2 Date of effect (DD/MM/YYYY)
E.C No. under Profession Tax Act, 1975
3 Date of effect (DD/MM/YYYY)
Details of Proprietor/ all Partners/Karta/Managing Directors and whole time Director/Members of
14.(A) Managing Committee of Associations /Board of Trustees / all persons having any interest in the
business.
Total Number of Persons
1
Please provide details in the table below. In case you need more tables, click on add table
·· In case of Proprietorship: Details of Owner/Proprietor.
· In case of Partnership: Details of all Managing/ Authorized Partners (personal details of all partners but
photos of only ten partners including that of Managing Partner is to be submitted)
· In case of Companies registered under Companies Act: Managing Director and whole time directors.
· In case of HUF: Details of Karta of HUF.
· In case of Trust: Details of Managing Trustee.
· In case of Association of Persons: Details of Members of Managing Committee(personal details of all
members but photos of only ten members including that of Chairman is to be submitted)
· In case of Local Authority: Details of CEO or equivalent.
· In case of Statutory Body: Details of CEO or equivalent.
· In case of others: Details of person responsible for day to day affairs of the business.
· In case of LLP, If Partners Registered then TIN, otherwise as above of all partners.
· Any other documents on which the address is available.
First Name Middle Name Last Name
Name of Person SANTOSH BHARGAV RAHATE
Name of Father/
BHARGAV RAHATE
Husband
Designation Status 001 Date Of Birth 17-Lie-73
PAN AGXPR0376F
POI
OCI
PTEC
TIN
PTRC
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PASSPORT
NUMBER
UID
DIN
MOB Number 9819241354
E-Mail Address [email protected]
Telephone
Gender : M Fax Number :
Residential Address
Building No/Flat No/Door No 4/92 Floor No 4 FLOOR
Name of the Premises/ NOORBANU Road/Street/Lane VISHNU GANESH PINGLE MARG
Building MANSION
District Mumbai * Taluka/Area MUMBAI (M. CORP)
Locality/Post/Village Parel Pin Code 400012
Latitude Longitude
Telephone No.2 with STD
Code
Mobile No. 2
Email Address 2
FAX 2
Declaration: - I hereby solemnly affirm and declare that the information given herein above is
true and correct to the best of my knowledge and belief and nothing has been concealed
therefrom.
I hereby authorise Maharashtra Sales Tax Department to collect the information
from UID authority.
Place : Name & Scanned Signature of applicant/ all Partners,
DESIGNATION :
Date :
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