FORM HSNS REG-02

[See rule 5(4)]

REGISTRATION CERTIFICATE

1. Registration Number: [ABCDE1234FHS001]

2. Legal Name: [Name of Sole Proprietor / Company / Partnership / HUF]

3. Trade Name, if any: [Trade Name]

4. Constitution of Business: [Proprietorship / Partnership / Pvt. Ltd / Public Ltd / LLP / HUF]

5. Address of Premise (Factory): [Full Address of the premises where machines/processes are located]

This is to certify that the person whose details are specified above has been registered under the provisions of the Health Security se National Security Cess Act, 2025, having acknowledged that they:

(i) Owns/possesses/operates/manages/controls the packing machines installed at the above premises; or

(ii) Undertake the manual process at the above premises; by which the Specified Goods (as defined in Schedule I of the Act) are manufactured or produced.

6. Nature of Possession of Premises/Machines: [Owned / Leased / Rented / Shared / Consent]

7. Date of Issue of RC : DD/MM/YYYY

8. Date from which the liability of payment of cess starts : DD/MM/YYYY

9. Jurisdiction Details:

• Commissionerate: [Code - Name]

• Division: [Code - Name]

• Range: [Code - Name]

Conditions

1. This Registration Certificate is valid only for the premises and purposes specified in the application

2. The registration certificate is not transferable.

3. No corrections in the certificate will be valid unless the request for any correction/change is applied for and the same is acknowledged.

4. This certificate shall remain valid till the Registrant carries on the activity for which it has been issued or it is cancelled.

5. The grant of this certificate shall be without prejudice to the rights of any other person (s) over the registered premises or purpose to which such person may be lawfully entitled.

Note:

1. This is a system-generated copy of the Registration certificate. Hence, there is no need for the signature/ stamp of the officer on it.

2. The Registration is subject to post facto verification of the details by the proper officer.