INC-35 Form language

1-10077264734_SRN_FORM
AGILE‐PRO-S English Hindi
(Application for Goods and services tax Identification number , employees state Insurance corporation registration
pLus Employees provident fund organisation registration, Profession tax Registration, Opening of bank account and
Shops and Establishment Registration)

[Pursuant to rule 38(A) of the Companies (Incorporation) Rules,2014]

Refer instruction kit for filing the form

All fields marked in * are mandatory

*Name of the Company CITADEL CLUB LEISURE (OPC)

PRIVATE LIMITED

1 *Do you want to apply for GSTIN Yes No

2 *State (Same as entered in SPICe+)

Maharashtra
3 *District (Same as entered in SPICe+)
Thane

4 State Jurisdiction

Sector / Circle / Ward /Charge / Unit

5 Centre Jurisdiction

Commissionerate

Division
DIVISION I
Range

6 Reason to Obtain Registration

Yes No
7 *Whether the Establishment on Lease

Leased from Date

Leased to Date

7a Nature of possession of premises Rented

(Own/Leased /Rented /Consent /SharedOthers)

If selected others,

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 b Proof of Principal place of Business
(Property Tax Receipt (TAXR)/Municipal Khata copy (CMUK),
Electricity Bill (ELCB)/ Rent/ Lease Agreement (RLAT),
Rent/ Lease Agreement (RLAT)
Consent Letter (CNLR)/Rent receipt with NOC (In case of no/expired agreement) (RNOC),
Legal ownership document (LOWN)

Proof of Principal place of business MAX 2MB

c *Whether the building/premises of establishment, is owned or hired

(Hired / Rented/Owned /Leased)
Hired / Rented

If hired or there is a change in the name of unit/ ownership, please indicate Yes No
Leased from Date
01/05/2023
Leased to Date
31/03/2024

8 Option for Composition

Yes No
8a Composition Declaration

I hereby declare that aforesaid business shall abide by the conditions and restrictions specified in the Act or Rules for opting to
pay tax under the composition levy.

b Category of Registered Person

Manufacturer of non‐notified goods

Supplier of food and non‐ alcoholic drinks
Any other eligible Supplier

9 Nature of Business Activity being carried out at above mentioned Premises (Please tick applicable)

Factory / Manufacturing,
Wholesale Business ,
Retail Business ,
Warehouse / Depot,
Bonded Warehouse,
Supplier of Services,
Office / Sale Office,
Leasing Business
Recipient of goods or services,
EOU / STP / EHTP,
Works Contract,
Export,
Import,
Others (Please specify)

9a *Primary Business Activity HOTEL

If Others selected, please

specify
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b*Exact nature of work / business Hotels & Restaurant

*Work Sub-Category Hotels

*Nature of Work Business

Hotels and Motels, inns, resorts pro

10 Details of the Goods supplied by the Business

HSN code (4 Digit)

Description of Goods

11 Details of Services supplied by the Business

Service Accounting Code (6 digit)

Description of Services

12 Director / Primary Owners / Office Bearer Details

(Minimum number of directors / Primary Owners / Office Bearers to be entered for OPC shall be 1, 2 in case of private company, 3 in case of
public limited company and 5 in case of Producer Company)

*Number of Director details to be entered

1
12a Enter Director details who is also an Authorized Signatory / Primary Owner / Office Bearer

(Search and select the name of the director)

DIN 10191075

BJXPL9453R
*PAN
WILSON
*First Name

Middle Name BENJAMIN

*Last Name
LONDHE

*Personal Mobile Number +918149971140

*Personal Email ID
directorwilsonlondhe@gmail.com

Do you wish to perform Aadhaar authentication for GSTN registration Yes No

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*Photograph Wilson Photo.jpg

Proof of appointment of Authorized Signatory for GSTN MAX 2MB

(Either of the following document can be attachedLetter of Authorization/Copy of Resolution passed by BoD/Managing Committee and
Acceptance letter)

*Specimen Signature of Authorized Signatory for EPFO Wilson Londhe Sign.pdf

b Director Details other than Authorized Signatory/Primary Owner / Officer Bearer

(Search and select the name of the director)

DIN

*PAN / Passport Number

*First Name

Middle Name

*Last Name

*Personal Mobile Number

*Personal Email ID

*Photograph MAX 2MB

13*Police Station Thane

14 Employer’s Particulars

*Select Appropraite Branch Office BO - Thane

*Select Inspection Division THANE

15 Bank Particulars

Select Bank Name Axis Bank

*Proof of Identity of Authorized Signatory for opening Bank Account Aadhar.pdf

*Proof of Address of Authorized Signatory for opening Bank Account Bank statement.pdf

16 Details for Shops and Establishment Registration

Whether registration is required under shops and establishment Yes No

a Category of Establishment

b Nature of Business

Declaration

GST Declaration (By Authorized Signatory)

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.

ESIC Declaration (By Office Bearer)

*I hereby declare that the statement given above is correct to the best of my knowledge and belief. I also undertake to intimate
changes if any, promptly to the Regional Office/Sub Regional Office, ESI Corporations as soon as such change takes place.

Professional Tax Declaration

The above information is true to the best of knowledge and belief

EPFO Declaration (By Primary Owner)

*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

Bank Declaration (By Authorized Signatory)

*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.
I authorize Axis Bank Bank and its officials to contact me/us on phone/ email/ SMS for the purpose of

opening of bank account.

I understand that the bank account number generated through this process will be shared with MCA by the banks.
I/we undertake to complete all documentary requirements as per bank KYC norms before activation of the account.

Shops and Establishment (Delhi) Declaration (By Primary Owner)

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.

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 *Place Thane

*Date
26/07/2023
*Designation
Director

DIN2 10191075
*To be digitally signed by director

*DIN/PAN 10191075

(Authorized Signatory / Primary Owner / Office Bearer signing the SPICe+ ‐AGILE‐PRO-S form shall provide his Permanent Account
Number)

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