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 Applicant : DHIRENDRA PRATAP YADAV
Address of the Applicant : 170/5 COLONELGANJ, ALLAHABAD
Details of Permanent Account Number(PAN) of the applicant
PAN Status : Allotted PAN : AFQPY8200B
Name of the Applicant(as appear- DHIRENDRA PRATAP YADAV
ing in PAN) :
Constitution Of applicant : Proprietorship
Government Department Type :
Name of Trustee/Proprietor/HUF : DHIRENDRA PRATAP YADAV
Category of Registrant : Service Provider
Nature of registration : Registration of a single premise
Taxable services provided : Commercial training or coaching
ADDRESS OF PREMISES FOR WHICH REGISTRATION IS SOUGHT
Name Of Premises/Building : DHIRENDRA PRATAP YA- Flat / Door / Block No : 170/5
DAV
Road / Street / Lane : Village / Area / Lane : COLONELGANJ
Block / Taluk / Sub-Division / 170/5 COLONELGANJ Post Office : COLONELGANJ
Town :
City / District : ALLAHABAD State / Union Territory : UTTAR PRADESH
PIN : 211002 Phone Number : 9450991012
Mobile Number : 9670075555 Fax Number-1 :
Fax Number 2 : Email Address : angelacademyalla-
habad@gmail.com
Commissionerate : ALLAHABAD Division : ALLAHABAD-II
Range : URBAN-II
NAME, DESIGNATION AND ADDRESS OF AUTHORIZED SIGNATORIES
Name : ANGEL ACADEMY Designation : Proprietor
Address : 170/5 COLONELGANJ ALLAHABAD
Phone Number : 9450991012 Email Address : angelacademyallahabad@gmail.com

Declaration

I, ANGEL ACADEMY,hereby declare that the information given in this application form is true,correct and com-
plete 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:

Date : 29/12/2016

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