Application to be Filed by the Dealer Who Request for Issue of Form-S (Rule [9(2)])
Dealer Details Contractee Details Work Contract Details
Sub Contract
& Works Completion Details
Previous Form S Details Annexure
Type of Dealer* Registered   Unregistered  
1. TIN  
2. Details of the Dealer who applies for Form S
 i. Name of the Dealer*  
 ii. Address of the Dealer
  a) Door / Plot No Old   b) Door / Plot No New*  
  c) Building Name   d) Shop / Office Number  
  e) Street / Road*   f) Village / Town / City*  
  g) District*   h) PIN*  
   i) Circle *
3. Section under which Tax is being paid and return filed*  
4. Whether returns filed up to the month* Yes   No