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ANNEXURE-IV
Form GST -
[See Rule __]
Application for Surrender of Registration under Goods and Services Tax Act, Year
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Please file your tax return for the tax period in which the effective date of cancellation of your registration falls before applying for cancellation.
Filed no. 2 to 5 would get auto populated on the basis of information mentioned in filed no.1.
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2. Full Name of Registrant
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3. Trade Name, if any
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4. Address of Principal Place of Business
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5. Address for correspondence
(e-mail, mobile, landline etc.)
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6.Reason for Surrender
Tick one
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Discontinuance of business
Death of sole proprietor
Has ceased to be liable to pay tax
Amalgamation etc.
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Closure of incorporated body
Dissolution of firm
Merger
Others (specify the reason)
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(Note: In case of death of Sole Proprietor application will have to be made by the legal heir / successor manually before the concerned tax authorities)
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7.In case of amalgamation or merger, provide
particulars of registration in which merged, amalgamated etc.
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(i) GSTIN
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(ii) Name
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(iii) Principal Place of Business
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(The new entity in which the applicant proposes to amalgamate itself must be registered with the tax authority before the filing of the surrender application. This application can only be made after that.)
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8. Date from which registration under -----Act, 20-- is to be surrendered
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Day |
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Year |
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9. Amount of GST payable in respect of goods / capital goods held on the date of surrender of registration (Rs.)
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10.Details of amount of GST
paid as calculated at 9 above.
(This needs to be amended in
view of maintenance of ITC /
Cash Ledger) |
i) Date of deposit
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Year |
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ii) Challan No.
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(iii) Name of Bank & Branch
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11. Verification
(i) I/We ________________________ hereby solemnly affirm and declare that the information given hereinabove is true and correct to the best of my/our knowledge and belief and nothing has been concealed therefrom.
(ii) I/We undertake to discharge any tax liability which is found to be payable subsequent to the surrender of registration and the tax authorities shall be free to take any action as prescribed in the law
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Signature of Authorised Signatory
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Full Name
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Designation/Status
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