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1 |
Name of the applicant |
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2 |
Profession/ trade/ calling (here specify the serial number
of the schedule under which liable To pay tax). |
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3 |
Address of the place of work (building/ street/ road/
municipal Ward/ town/ city / tehsil/ district) |
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4 |
* Date of commencement of Profession/trade/calling |
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5 |
* Period of standing in the Profession |
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* Number of beds (in the case of residential hotels) |
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* Whether a state level society, A district level society a
co-operative sugar factory or a co-operative sugar mill. |
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* Average number of employees during a year employed in the
establishment. |
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* Average number of workers during a year.- |
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* Annual gross turnover |
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*number of, - |
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(i) Three wheeler passenger/ Goods vehicles |
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(ii) Taxi/ four wheeler light passenger/ goods vehicles. |
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(iii) Heavy passenger/ goods Vehicles |
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6 |
Income during the previous year (to be given by a person
opting to pay tax under sub-section (3) of section 3. Here
state specifically whether option under sub-section (3) of
section 3 is being exercised or not. |
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7 |
If carrying on a profession trade or calling other than
agriculture in addition to an employment, the particulars
thereof or if simultaneously engaged in employment of more
than one employer the names and addresses of all such
employers and the monthly salary received from each of them. |
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8 |
Names and addresses of additional places of work if any, in
the state of Chhattisgarh. |
1 |
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2 |
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3 |
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9 |
If registered under the Chhattisgarh Vanijyik Kar Adhiniyam,
1994/ Central Sales Tax Act, 1956 the number of the
registration certificate, - |
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(a) Under Chhattisgarh Vanijyik Kar Adhiniyam |
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(b) Under Central Sales Tax Act |
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The above statements are true to the best of my knowledge
and belief. |
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Place : |
Signature |
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Date : |
Status |
