¹[FORM GST ENR-03 

[See rule 138(3)] 

Application for Enrolment 

[only for un-registered persons] 

1. Name of the State 

2. (a) Name as per PAN 

(b) Trade Name, if any 

(c) PAN 

(d) Aadhaar, if applicable (optional) 

3. Type of enrolment 

(i) Unregistered supplier of goods 

(ii) Unregistered recipient of goods 

(iii) Both (i) & (ii) 

4. Contact Information (the email address and mobile number will be used for authentication) 

Email Address 

Mobile Number 

5. Consent 

I on behalf of the holder of Aadhaar number 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. 

6. List of documents uploaded 

7. 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:    Signature 

Date:                                                                                                        

Name of Authorised Signatory 

For Office Use: 

Enrolment no 

Date- ]₁