69. Form GST PCT - 1

Form GST PCT – 1

[See Rule 83(1 ]

Application for Enrolment as Goods and Services Tax Practitioner Part –A

State /UT – District –

(i)	Name of the Goods and Services Tax Practitioner (As mentioned in PAN)
(ii)	PAN
(iii)	Email Address
(iv)	Mobile Number
*Note* – Information submitted above is subject to online verification before proceeding to fill up Part-B.

PART B

1.	Enrolling Authority	Centre State
2.	State/UT
3.	Date of application
4	Enrolmentsoughtas:	Chartered Accountant holding COPCompany Secretary holding COPCost and Management Accountant holding COPAdvocateGraduate or Postgraduate degree in CommerceGraduate or Postgraduate degree in BankingGraduate or Postgraduate degree in Business AdministrationGraduate or Postgraduate degree in Business ManagementDegree examination of any recognized Foreign UniversityRetired Government Officials
5.	Membership Number
5.1	Membership Type (drop down will change based the institute selected )
5.2	Date of Enrolment / Membership
5.3	Membership Valid upto

6	Advocates registered with Bar (Name of Bar Council)
6.1	Registration Number as given by Bar
6.2	Date of Registration
6.3	Valid up to
7	Retired Government Officials	Retired from Centre/ State
7.1	Date of Retirement
7.2	Designation of the post held at the time of retirement	Scanned copy of Pension Certificate issued by AG office or any other document evidencing retirement
8.	Applicant Details
8.1	Full name as per PAN
8.2	Father’s Name
8.3	Date of Birth
8.4	Photo
8.5	Gender
8.6	Aadhaar	<optional>
8.7	PAN	< Pre filled from Part A>
8.8	Mobile Number	<Pre filled from Part A>
8.9	Landline Number
8.10	Email id	< Pre filled from Part A>
9.	Professional Address	(Any three will be mandatory)
9.1	Building No./ Flat No./Door No.
9.2	Floor No.
9.3	Name of the Premises / Building
9.4	Road / Street Lane
9.5	Locality / Area / Village
9.6	District
9.7	State

9.8	PIN Code
10.	Qualification Details
10.1	Qualifying Degree
10.2	Affiliation University / Institute
	Consent I on behalf of the holder of Aadhaar number <pre-filled based on Aadhaar number provided in the form> give consent to “Goods and Services Tax Network” to obtain my details from UIDAI for the purpose of authentication. “Goods and Services Tax Network” has informed me that identity information would only be used for validating identity of the Aadhaar holder and will be shared with Central Identities Data Repository only for the purpose of authentication. Verification I hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief and nothing has been concealed therefrom.
	Place	< DSC /E-sign of the Applicant/EVC>
	Date	< Name of the Applicant>

Acknowledgment

Application Reference Number (ARN) -You have filed the application successfully. GSTIN, if available:

Legal Name:

Form No. :

Form Description :

Date of Filing:

Time of filing:

Center Jurisdiction:

State Jurisdiction :

Filed by :

Temporary reference number, (TRN) if any:

Place:

It is a system generated acknowledgement and does not require any signature.

Note – The status of the application can be viewed through “Track Application Status” at dash board on the GST Po