Chhattisgarh Professional Tax Act - 1995

FORM 4

[See Rule 3 (3)]

Certificate of Registration (for person)

No............................                                                                            District.......................

This is to certify .............................................................................engaged in *profession / trade / calling Known as............................................* / simultaneously in a profession, trade or calling other than agriculture in addition to employment with the principal place of work, located work at …………….. has been registered under the Chhattisgarh Vritti Kar Adhiniyam , 1995

The holder of this certificate has additional places of work at the following addresses;-

1.                   ………………………………………………………………….

2.                  ………………………………………………………………….

3.                  ………………………………………………………………….

4.                  ………………………………………………………………….

[seal].

Place :                                                                               Signature...................................

Date    :                                                                              Designation................................

*strike out whichever is not applicable.