SDR PRA REF REG

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Service Tax Registration - ST-1 Form

FORM ST-1 [Application form for registration under Section 69 of The Finance Act,1994(32 of 1994)] IDENTIFICATION OF BUSINESS REQUIRING REGISTRATION Name of ApplicantMadhur Enterprises Address of the ApplicantDhaka Road In front of central Details of Permanent Account Number(PAN) of the applicant PAN StatusAllotted PAN (If Allotted)APUPK7413A Name of the Applicant(as appearing in PAN)PANKAJ KUMAR Constitution Of applicantProprietorship Name of Trustee/Proprietor/HUFPankaj Kumar Category of RegistrantService Provider, Service Recipient Nature of registrationRegistration of a single premise Taxable services providedOther than in the negative list ADDRESS OF PREMISES FOR WHICH REGISTRATION IS SOUGHT Name Of Flat / Door / Block Opp Central Bank Dhaka Road Premises/Building No Road / Street / Village / Area / Chatauni Lane Lane Block / Taluk / Sub-Division /Motihari Post OfficeMotihari Town State / Union City / DistrictE Champaran BIHAR Territory PIN845401 Phone Number-18986241765 Phone Number-2 Fax Number Fax Number-1 Email Address pankajk984@gmail.com

CommissioneratePATNA Range:MOTIHARI

DivisionLAHERIA SARAI

NAME, DESIGNATION AND ADDRESS OF AUTHORIZED SIGNATORIES NamePankaj Kumar AddressAt Narayanapur Po Naraipur Bagaha 2 Phone Number8986241765 DECLARATION Email Address pankajk984@gmail.com DesignationProprietor

I, Pankaj Kumar ,hereby declare that the information given in this application form is true,correct and complete in every respect and that I am authorised to sign on behalf of the Registrant. (a) For new Registration :I would like to receive the Registration Certificate by mail/by hand/E-MAIL (b) For amendments to information pertaining to existing Registrant :Date from which amendments are made: