FORM GST REG-04
[See rules 9(2), 19(3) and 14A]

Clarification/additional information/document for <<Registration/Amendment/Cancellation/Withdrawal >>

1. Notice details Reference No.   Date  
2. Application details Reference No.   Date  
3. GSTIN/GSTP ID, if applicable

 
4. Name of Business (Legal)

 
5. Trade name, if any

 
6. Address

 
7. Whether any modification in the application for registration or fields is required.- Yes ◼

No ◼

(Tick one)
8. Additional Information  
9. List of Documents uploaded  
10. Verification

I ________________________________________  hereby solemnly affirm and declare that the information given hereinabove is true and correct to the best of my knowledge and belief and nothing has been concealed therefrom.

Signature of Authorised Signatory

Name
Designation/Status:

Place:

Date:

Note: -

1.For new registration, original registration application will be available in editable mode if option ‘Yes’ is selected in item 7.

2.For amendment of registration particulars, the fields intended to be amended will be available in editable mode if option "Yes" is selected in item 7.

3.For withdrawal from option availed under rule 14A, item 7 will be disabled.