SPECIMEN FOR APPOINTING AUTHORIZED REPRESENTATIVE REQUIRED FOR ENROLLMENT IN THE GOODS AND SERVICE TAX (GST) ACT

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 aforementioned purpose.

Full name of the person	_____________________
Designation	_____________________
E-mail id	_____________________
Place	{city} - Date ___/____/2016
Signature of authorized representative	_____________________________________
Signature of Attestor Check the updated list of documents required for the enrollment in GST ACT