Gst Registration Gst Reg 4

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Department of ---------------------- 

Form GST REG-04 
[See Rule ----] 

Application for filing clarification/additional information/document for 
<<Registration/Amendment/Cancellation/Revocation of Cancellation>> 

1. 

Reference  No.  of  Notice 

Application  Reference  No. 
(ARN) 

GSTIN,  if  applicable 

Date 

Date 

Change  in  the  Application  filed.- 

Yes 

¢ 

No 

¢   (Tick one) 

Note  –  Original  application  will  be  available  in  editable  mode  if  Yes  is  selected,  else,  field  for 
additional  information  will  get  displayed 

Additional  Information 

Verification 

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 there from. 

E-Sign  /  Digital  Signature 

of  Authorised  Signatory 

Full  Name 

(first  name,  middle,  surname) 

Designation/Status  _ 

Place 

Date   ---   DD/MM/YYYY 

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