Application for registration under section 69

Of the Finance Act, 1994 (32 of 1994)


1.      Name of the assessee :


2. Address of the assessee :


2A. PAN Number


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


(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 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

Authorized representative