Tax Payment Certificate (Under Section 4) (For Monthly Tax Payment)

[See Rule 12] Tax Payment Certificate (Under Section 4) (For Monthly Tax Payment)

1. Registration No. of the vehicle ...................................Model ………. 2. Date of Registration............................................................ 3. Name of the Owner ...............................................................

4. Address............................................................................... 5. Route ………………………………………………….. 6. Length of Route (in Kilometer) …………………………….. 7. Number of Trips in Calendar month ……………………………. 8. Kilometer covered in a month …………………………….. 9. Seating Capacity (Including Driver)............................................. 10. Amount of tax in a calendar month ……………………………… 11. Amount of monthly installment ……………………………. 12. Due Amount if any ………………………. 13. Details of payment ……………………………….

Year ……………………………………………………….…………………….

SI. No. Name of Calendar Month Paid of amount (in Rs.) Receipt No. Date Signature of the Taxation Officer 1. January 2. February 3. March 4. April 5. May 6. June 7. July 8. August 9. September 10. October 11. November 12. December

Signature of the Taxation Officer Date .................................. Region/sub-region