An Autonomous Institution of Government of Kerala

(An Autonomous Institution of Government of Kerala) GIFT Campus, Chavadimukku, Sreekariyam P.O, Thiruvananthapuram – 695 017, Kerala, India Phone: 0471 – 2596960, 2596970, 2596980, 2590880 e-mail: [email protected] Website: www.gift.res.in

Application for recognition process for holders of Diploma in Sales Taxation of GIFT as Sales Tax Practitioners (Diploma) and Issuance of Photo Identity Card [Refer G.O(Ms.)No.210/2015/TD dated 27.11.2015 Taxes Department, Government of Kerala] Application No:

1. Name (IN CAPITALS) (as per SSLC) 2. Age , Date of Birth and Blood Group 3. Gender Male/Female

4. Address for communication supported by proof of Identity (IN CAPITALS)

District : Pin : Land Phone No : Mobile No : E-mail : Reg No.

5. Diploma in Sales Taxation of GIFT Year of Pass Student Code Number University/ Register Year Educational Qualification 6. Institution No. of Pass

a) SSLC

b) Other Qualifications (if any) 7. Enclosures : a) For Address proof i. Aadhaar Card / Election ID / Driving License (Self Attested Photo Copy) ii. One Passport Size Photo b) For Proof of Education Qualification Self attested Photocopies of the Certificates: i. DST Certificate ii. DST Mark list iii. Any other Degree (if any)  Original documents will be produced at the time of training programme.

8. Fee to the remitted :

A. Sum of (Rs.12000* ) Rupees Twelve Thousand Only has been paid in favour of Registrar, GIFT by Cash / Demand Draft /NEFT Payment **

D.D Details: No. ------Dated ------of ------branch of ------Bank payable at Thiruvananthapuram.

NEFT Payment Ref. No. ------

(Please attach the copy of online receipt)

**Bank Details :

Bank : ICICI Bank, Sreekaryam Branch

Account No : 185601000254

IFSC Code : ICIC0001856

MICR : 695229013

* * Fee includes ID Card, Training Expense & KTR subscription with discount-

for the year 2017 DECLARATION

I, (Name) ------do hereby declare that the information furnished above are true, correct and complete to my knowledge and belief and if at any time it be proved that particulars given above are untrue, I agree my identity card and Certificate issued by GIFT be cancelled without any obligation on the part of GIFT to refund the fee paid already and without prejudice to the right of GIFT to take any action if it thinks to be fit and appropriate.

Place: ……………………. Date: ………………….…. Signature

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FOR OFFICE USE ONLY