Schedule -3
(Relating to rule 4)
Tax Assessment Form
Taxpayer’s name:-
Address:-
Taxpayer’s fiscal year:-
Fiscal year of tax assessment:-
Tax assessment number

Statement
Five copies of voucher for payment of a total sum of Rs………………. comprising
total rent tax of Rs……………… And penalty of Rs……………at ……………. place
within Thirty Five days are attached herewith. If you do not pay the amount
within the said time limit, tax along with interest thereon shall be recovered as
a governmental due pursuant to Section 12 of the Act.
(Tax Officer’s signature)
Date:-