Schedule – 1
(Relating to Sub-rule (1) of Rule 3)
To,
The Tax Office,
………………..Zone.
I have, hereby, furnished the following statement of the taxable house and land rent for the fiscal year……………, within the time-limit as referred to in the House and Land Rent Tax Act. If the statement is held to be false, I shall
bear and pay according to the prevailing Nepal law.

Tax payer’s name: – Signature:-
Address: – Name of signature maker –
Address –
Date –