Form GST REG-12
[See rule 16(1)]

Date:   

Reference Number -

To
(Name):
(Address):
Temporary Registration Number

Order of Grant of Temporary Registration/ Suo Moto Registration

Whereas the undersigned has sufficient reason to believe that you are liable for registration under the Act, and therefore, you are hereby registered on a temporary basis. The particulars of the business as ascertained from the business premises are given as under:

Details of person to whom temporary registration granted
1. Name and Legal Name, if applicable  
2. Gender Male/Female/Other
3. Father’s Name  
4. Date of Birth DD/MM/YYYY
5. Address of the Person Building No./ Flat No.  
Floor No.
Name of Premises/ Building
Road/ Street
Town/City/Locality/ Village
Block / Taluka
District
State
PIN Code
6. Permanent Account Number of the person, if availabl  
7. Mobile No.  
8. Email Address  
9. Other ID, if any
(Voter ID No./ Passport No./Driving License No./
Aadhaar No./ Other)		  
10. Reasons for temporary registration  
11. Effective date of registration / temporary ID  
12 Registration No. / Temporary ID  
13 Total number of Bank Accounts maintained by the applicant (Upto 10 Bank Accounts to be reported)  
 

Details of Bank Account 1

Account Number                              
Type of Account   IFSC
Bank Name  
Branch Address To be auto-populated (Edit mode)

Note-Add more bank accounts”.

 
(Upload of Seizure Memo / Detention Memo / Any other supporting documents)
<<You are hereby directed to file application for proper registration within 90 days of the issue of this
order>>

Signature
 << Name of the Officer>>:
 Designation/ Jurisdiction:
 

Place
Date:

Note: A copy of the order will be sent to the corresponding Central/ State Jurisdictional Authority.