AGILE-PRO-S

FORM NO. INC-35

[Pursuant to rule 38(A) of the (Application for Goods and services tax
Identification number, employees state
Companies (Incorporation) Rules,
2014] Insurance corporation registration pLus
Employees provident fund organization
registration, Profession Tax Registration and
Opening of Bank Account and Shops and
Establishment Registration)

(This AGILE-PRO-S form is part of SPICe+ form for GSTIN / EPFO / ESIC/ Profession Tax/ Bank Account/Shops and
Establishment Registration)

* Name of the company FIBIDOFX (OPC) PRIVATE LIMITED

1. * Do you want to apply for GSTIN Yes No

2. * State (Same as entered in SPICe+) Uttar Pradesh-UP

3. * District (Same as entered in SPICe+) Lucknow
4. * State Jurisdiction Sector
* Sector / Circle / Ward /Charge / Unit
5. * Center Jurisdiction

Commissionerate

Division
Range

6. * Reason to Obtain Registration Voluntary

7. * Whether the Establishment On Lease YES NO
* Leased From Date To Date

(a).* Nature of possession of premises

(b).* Proof of Principal Place of Business

(c).*Whether the building/premises of Establishment.is owned or hired Hired/Rented

* If hired or there is a change in the name of Unit/ownership, please indicate YES NO
Leased From Date 19/01/2022 To Date 18/12/2022

8. * Option for Composition Yes No

(a) Composition Declaration

I hear by 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/Deport Bonded Warehouse Supplier of services

Office/Sale Office Leasing Business Recipient of goods or services

EOU/ STP/ EHTP Works Contract Export

Import Others (specify)

If others, please specify

(A) * Primary Business Activity

OTHERS

If others selected, please specify Advisory and consulting services

(B) *Exact nature of work / business
Miscellaneous

*Work Sub-category MISC12

*Nature of work business Advisory and consulting services

10. * Details of Goods supplied by the Business

HSN Code (Four Digit) Pre-fill

Description of Goods

11. * Details of Services supplied by the Business.

Service Accounting Code Pre-fill

Description of Services

12. Director / Primary Owners / Office Bearer Details

(Minimum number of directors 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
(A). Enter Director details who is also an Authorised Signatory / Primary Owner / Office Bearer

* Director Identification Number (DIN) Permanent Account Number (PAN) Photograph

*DIN 07436896 Pre-fill

*PAN AHDPR3443E pic_CARANI512_202201201
*First Name GUNDEPUDI
Attach Remove
Middle Name VENKATA Photograph Photograph
*Last Name RAMANA Attach a latest passport
Send OTP
*Personal Mobile Number +91 8341715711 size photograph by
*Personal Email Id clicking the above box
[email protected]
*Enter OTP for Mobile Number 271051 Verify OTP
*Enter OTP for Email Id 926530

*Do you wish to perform Aadhaar authentication for GSTN registration YES NO
 (B). * Director Details other than Authorised Signatory / Primary Owner / Office Bearer

* Director Identification Number (DIN) Permanent Account Number / Passport Number(incase of

foreign national) Photograph
*DIN Pre-fill
*PAN / Passport Number
*First Name
Attach Remove
Middle Name Photograph Photograph
*Last Name Attach a latest passport
*Personal Mobile Number size photograph by
clicking the above box
*Personal Email Id

13. *Police Station

Lucknow
14. *Employer's Particulars

*Select Appropriate Branch Office

BO - Lucknow (Kapoorthala)

*Select Inspection Office

ID - Lucknow-1
15. *Bank Particulars

. *Select Bank Name

Kotak Mahindra Bank

Attachments

1. *Proof of Principal place of business Attach

2. *Proof of appointment of Authorized Signatory for GSTN Attach
(Either of the following document can be attached.
Letter of Authorisation / Copy of Resolution passed by BoD /
Managing Committee and Acceptance letter)

3. *Proof of Identity of Authorized Signatory for opening Attach

GVRAMIDADDRESS_CARANI512_20
Bank Account
4. *Proof of Address of Authorized Signatory for opening GVRAMIDADDRESS_CARANI512_20 Attach
Bank Account
5. *Specimen Signature of Authorized Signatory for EPFO Attach
SpecimenSign_CARANI512_2022012
 GST Declaration (by Authorised 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 Corporation as soon as such
change takes place.

Profession Tax Declaration

The above information is true to the rest of the 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 Kotak Mahindra 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.

Place Lucknow

Date 21/01/2022

Designation Director

* To be digitally signed by director (who has signed the SPICe+ form)

* DIN/PAN 07436896

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