Particulars for
Authorized Representative
1.
|
Name
of the Firm :
|
________________________________
|
2.
|
Place
of business with address
|
________________________________
________________________________
________________________________
|
3.
|
Full
name of the authorized representative
|
________________________________
|
4.
|
Designation
:
|
________________________________
|
5.
|
Permanent
Residential Address :
|
________________________________
|
________________________________
|
||
________________________________
|
||
________________________________
|
||
E-mail
id
|
________________________________
|
|
Telephone
Number(s)
|
________________________________
|
|
Mobile
Number(s)
|
________________________________
|
|
Fax
Number(s)
|
________________________________
|
|
6.
|
Period
for which authorized to act as an authorized representative
|
________________________________
|
Declaration:-
I/we
declare that the person named above is authorized to act as an authorized
representative for the above referred business for the purpose of collecting
GST Id and password only. His action in relation to this business shall be
binding on me/us.
Signatories:-
Full name Signature Status
Acceptance as an
authorized Representative:-
I,
accept to act as an authorized representative for the above referred business
for the afore-mentioned purpose.
Full
name of the person
|
_____________________
|
Designation
|
_____________________
|
E-mail
id
|
_____________________
|
Place
|
{city} - Date ___/____/2016
|
Signature
of authorized representative
|
_____________________________________
|
Signature
of Attestor
|
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