GSTIN DECLARATION FORM

In order to enable us to report the details of the GST collected from you in the GST
returns submitted by us, we request the Customers who have obtained Goods and
Service Tax Identification Number (GSTIN), to furnish their GSTIN details in the
following format, along with a self attested photocopy of the GSTIN allotment
communication to our Branch.

GSTIN Information
SL.NO GSTIN DETAILS DETAILS TO BE FILLED UP BY CUSTOMER

1. Name of the Customer

2. Customer ID
3. Account No.
4. PAN
5. GST Identification Number (GSTIN)
6. TAN
7. Composition Scheme (Please indicate) (Yes / No)
8. Nature of Service Rendered – as given the
Registration Certificate issued by the
authorities

9. Constitution of Business (Pl. Tick) Company Partnership Proprietary Others,

plz
specify

10. Address of principal place of Address

business in the state as per
GST registration Certificate City

PIN

State

Multiple GST Registration (Yes / No)

(If yes Please fill the following details)
GST Identification Number (GSTIN)
 Address of principal place of Address
business in the state as per
GST registration Certificate City

PIN

State

GST Identification Number (GSTIN)

Address of principal place of Address

business in the state as per
GST registration Certificate City

PIN

State

11. Location SEZ/STP/D

TA

12. Contact details Name

E-mail ID

Phone No.

Name of Authorized Signatory/Primary Holder Signature

Name of Authorized Signatory/Joint Holder1 Signature

Name of Authorized Signatory/Joint Holder2 Signature

** In case of multiple GST Registration number, applicant may detail the GST
registration of particular state for every transaction or else the default address
mentioned in the form shall be selected by the bank for issuance of invoice.

*************