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1729169164237
[Pursuant to rule 38(A) of the Companies (Incorporation) Rules,2014]
Refer instruction kit for filing the form
All fields marked in * are mandatory 1-15467617007_SRN_FORM_1729169164237
*Name of the Company RADHE KRISHNA SARV SAMAJ
FOUNDATION
1 *Do you want to apply for GSTIN Yes No
2 *State (Same as entered in SPICe+) Bihar
3 *District (Same as entered in SPICe+) Darbhanga
4 State Jurisdiction
Sector / Circle / Ward / Charge / Unit
5 Centre Jurisdiction
Commissionerate
Division
Range
6 Reason to Obtain Registration
7 *Whether the Establishment on Lease Yes No
Leased from Date
Leased to Date
7a Nature of possession of premises
(Own/Leased /Rented /Consent /SharedOthers)
If selected others,
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b Proof of Principal place of Business
(Property Tax Receipt (TAXR)/Municipal Khata copy (CMUK),
Electricity Bill (ELCB)/ Rent/ Lease Agreement (RLAT),
Consent Letter (CNLR)/Rent receipt with NOC (In case of no/expired agreement) (RNOC),
Legal ownership document (LOWN)
Proof of Principal place of business MAX 2MB
c *Whether the building/premises of establishment, is owned or hired
(Hired / Rented/Owned /Leased) Owned
If hired or there is a change in the name of unit/ ownership, please indicate Yes No
Leased from Date
Leased to Date
8 Option for Composition
Yes No
8a Composition Declaration
I hereby declare that aforesaid business shall abide by the conditions and restrictions specified in the Act or Rules for opting to
pay tax under the composition levy.
b Category of Registered Person
Manufacturer of non-notified goods
Supplier of food and non- alcoholic drinks
Any other eligible Supplier
9 Nature of Business Activity being carried out at above mentioned Premises (Please tick applicable)
Factory / Manufacturing,
Wholesale Business ,
Retail Business ,
Warehouse / Depot,
Bonded Warehouse,
Supplier of Services,
Office / Sale Office,
Leasing Business
Recipient of goods or services,
EOU / STP / EHTP,
Works Contract,
Export,
Import,
Others (Please specify)
9a *Primary Business Activity OTHERS
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If Others selected, please specify Educational support services, Other human
health activities n.e.c.
b *Exact nature of work / business Miscellaneous
*Work Sub-Category Others
*Nature of Work Business (including independent ambulance
activities),Other social work activities
without accommodation n.e.c.
10 Details of the Goods supplied by the Business
HSN code (4 Digit)
Description of Goods
11 Details of Services supplied by the Business
Service Accounting Code (6 digit)
Description of Services
12 Director / Primary Owners / Office Bearer Details
(Minimum number of directors / Primary Owners / Office Bearers to be entered for OPC shall be 1, 2 in case of private company, 3
in case of public limited company and 5 in case of Producer Company)
*Number of Director details to be entered 2
12a Enter Director details who is also an Authorized Signatory / Primary Owner / Office Bearer
(Search and select the name of the director)
DIN
*PAN EQ******4B
*First Name NAWIN
Middle Name
*Last Name KUMAR
*Personal Mobile Number +91********77
*Personal Email ID uj*****************il.com
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Do you wish to perform Aadhaar authentication for GSTN registration
Yes No
*Photograph Nawin Kumar.jpg
Proof of appointment of Authorized Signatory for GSTN MAX 2MB
(Either of the following document can be attachedLetter of Authorization/Copy of Resolution passed by BoD/Managing Committee
and Acceptance letter)
*Specimen Signature of Authorized Signatory for EPFO Specimen.pdf
b Director Details other than Authorized Signatory/Primary Owner / Officer Bearer
DIN
*PAN / Passport Number CR******3A
*First Name PALLAVI
Middle Name
*Last Name KUMARI
*Personal Mobile Number +91********17
*Personal Email ID pa**********************il.com
*Photograph Photo pallavi .jpg
13*Police Station Keoti
14 Employer’s Particulars
*Select Appropraite Branch Office DCBO - Darbhanga
*Select Inspection Division ID-Muzaffarpur (Darbhanga)
Select Bank Name State Bank of India
*Proof of Identity of Authorized Signatory for opening Bank Account Nawin ID.pdf
*Proof of Address of Authorized Signatory for opening Bank Account Nawin Bank.pdf
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Whether registration is required under shops and establishment Yes No
a Category of Establishment
b Nature of Business
Declaration
GST Declaration (By Authorized Signatory)
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.
ESIC Declaration (By Office Bearer)
*I hereby declare that the statement given above is correct to the best of my knowledge and belief. I also undertake to intimate
changes if any, promptly to the Regional Office/Sub Regional Office, ESI Corporations as soon as such change takes place.
Professional Tax Declaration
The above information is true to the best of knowledge and belief
EPFO Declaration (By Primary Owner)
*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
Bank Declaration (By Authorized Signatory)
*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 authorize State Bank of India Bank and its officials to contact me/us on phone/ email/ SMS for the purpose of
opening of bank account.
I understand that the bank account number generated through this process will be shared with MCA by the banks.
I/we undertake to complete all documentary requirements as per bank KYC norms before activation of the account.
Shops and Establishment (Delhi) Declaration (By Primary Owner)
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.
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*Place Darbhanga
*Date 17/10/2024
*Designation Director
*To be digitally signed by director
*DIN/PAN EQ******4B
(Authorized Signatory / Primary Owner / Office Bearer signing the SPICe+ -AGILE-PRO-S form shall provide his Permanent Account
Number)
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