Form GST REG-04
[See rule 9(2)]
Clarification/additional information/document
for <<Registration/Amendment/Cancellation>>

1. Notice details Reference No.   Date  
2. Application details Reference No.   Date  
3. GSTIN, 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.