Order of assessment of an employee/person

Name of the employer/ person ___________ Address of the employer/person ____________ Registration Certificate No. ______________ Period of assessment ___________ Assessment case No. _____________ As returned As determined No. of employees Rate of tax Amount of tax to be deducted No .of employees Rate of tax Amount of tax to be deducted (1) (2) (3) (4) (5) (6) (7) Less than Rs. 40001

Rs. 40001 to Rs. 50000

Rs. 50001 to Rs. 60000

Rs. 60001 to Rs. 80000

Rs. 80001 to Rs. 100000

Rs. 100001 to Rs. 150000

Exceeding Rs. 1,50,000

Amount of tax as returned Amount of tax as determined 2. Particulars of profession/trade/calling (category of the schedule under which liable to pay tax 3. Penalty under section (i) _________ (ii) _________ (iii) 4.. Total amount of tax/penalty 5.Amount paid alongwith returns 6. Balance payable/excess payment Seal ....................................... Place.......................... Date........................... Signature Designation______________ *Strike out whichever is not applicable