FORM 1

[See Rule 3(1)]

Application No………….
Under the Karnataka Tax on Professions, Trades, Callings and Employment Act, 1976
I hereby apply for a Certificate of Registration under the above mentioned Act as per
particulars given below:
Sl. No. Particulars
1 Name of the Applicant

1
[2 Nature of the profession, trade, etc
Nature of the profession, trade, etc
Full postal address and telephone nos. of the main
place of work
Full postal address and telephone nos of any
additional place/s of work ]
3 Class of employer : - Individual -1, Partner – 2, Firm –
3, Company – 4, Corporation – 5, Society – 6, Club
and Association – 7, Other Specify - 8
4 Status of person signing this form :- Proprietor – 1,
Partner – 2, Principal Officer – 3, Agent – 4, Manager
– 5, Director – 6, Secretary – 7, Others Specify - 8

The above statements are true to the best of my knowledge and belief.
Date: Signature with Status
Registration No:
Date of Issue: Signature of the Issuing Officer

Acknowledgement
(Particulars of name and address to be filed in by applicant)
Received an application for registration in Form -1
From: Application No………………
Name:
Address:
Date: Signature of the Receiving Officer
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Sl.no 2 and entries relating thereto substituted by Notification No. FD 166 CSL 2007, dated 30-8-2007 w.e.f 1-4-2007