Chhattisgarh Professional Tax Act - 1995

FORM 5

(See rule 9)

Certificate to be furnished by person to his employer

I, ………………………… (Name of the person) ………………………………

.. (Address) hereby certify that I am engaged in the profession. Trade or calling specified in entry ……………………………………………………. of the schedule to the Chhattisgarh Vritti Kar Adhiniyam, 1995 and that the rate of tax payable by me under the said entry is more than the rate of tax payable under entry 1 in the said schedule in respect of my employment with …………………………………… (Name of the employer) ………………………………………… (Address).

I also certify that, *I shall get myself registered and shall pay the tax myself under the said entry.

                                                        OR

*I have got myself registered under registration certificate No. ………………….. dated ……………………………………… and shall pay the tax/ have paid the tax Stated therein myself.

PLACE : ………….

DATE : …………

Signature