For Depositor For Depositor

FORM III - RETURN - CUM - CHALLAN FORM III - RETURN - CUM - CHALLAN
The Maharashtra State Tax on Professions The Maharashtra State Tax on Professions
Trades Callings and Employment Act 1975 And Rule Trades Callings and Employment Act 1975 And Rule
11 Made Thereunder 028. Other Taxes on Income And 11 Made Thereunder 028. Other Taxes on Income And
Expenditure - Taxes on Profession, Trades, Expenditure - Taxes on Profession, Trades,
Callings And Employments - Taxes on Employments Callings And Employments - Taxes on Employments
Employees Whose Monthly Rate of Tax No. of Amount of For Treasury Employees Whose Monthly Rate of Tax No. of Amount of
Salaries, Wages are Per Month Employees Tax Deducted Salaries, Wages are Per Month Employees Tax Deducted
Upto Rs.2500/- Nil 0 Nil FORM III - RETURN - CUM - CHALLAN Upto Rs.2500/- Nil 0 Nil
Rs.2501/- to 3500/- Rs.0/- 0 0.00 The Maharashtra State Tax on Professions Rs.2501/- to 3500/- Rs.0/- 0 0.00
Rs.3501/- to 5000/- Rs.0/- 0 0.00 Trades Callings and Employment Act 1975 And Rule Rs.3501/- to 5000/- Rs.0/- 0 0.00
Rs.5001/- to 10000/- Rs.175/- 8 1400.00 11 Made Thereunder 028. Other Taxes on Income And Rs.5001/- to 10000/- Rs.175/- 8 1400.00
Rs.10001/- & above Rs.300/- 34 6800.00 Expenditure - Taxes on Profession, Trades, Rs.10001/- & above Rs.300/- 34 6800.00
Total 42 Callings And Employments - Taxes on Employments Total 42
Tax Amount Rs. 8200.00 Tax Amount Rs. 8200.00 Tax Amount Rs. 8200.00
Interest Amount Rs. 0.00 Interest Amount Rs. 0.00 Interest Amount Rs. 0.00
Penalty Amount U/s………. Rs. 0.00 Penalty Amount U/s………. Rs. 0.00 Penalty Amount U/s………. Rs. 0.00
Composition Money Rs. 0.00 Composition Money Rs. 0.00 Composition Money Rs. 0.00
Total Amount Rs. 8200.00 Total Amount Rs. 8200.00 Total Amount Rs. 8200.00
Profession Tax Registraction Period Period Profession Tax Registraction Period Period Profession Tax Registraction Period Period
Certificate No. From To Certificate No. From To Certificate No. From To
1500000 01/08/2010 31/08/2010 1500000 01/08/2010 31/08/2010 1500000 01/08/2010 31/08/2010

Name and Address Name and Address Name and Address

ABC PVT. LTD ABC PVT. LTD ABC PVT. LTD

ADDRESS1 ADDRESS1 ADDRESS1
NASHIK 422 010. NASHIK 422 010. NASHIK 422 010.
PHONE : 0000 PHONE : 0000 PHONE : 0000

The above Statements are true to the best of my knowledge and belief. The above Statements are true to the best of my knowledge and belief. The above Statements are true to the best of my knowledge and belief.

for ABC Pvt. Ltd., for ABC Pvt. Ltd., for ABC Pvt. Ltd.,

Date : / /2010 Date : / /2010 Date : / /2010

Place : Nashik Authrosied Signatory Place : Nashik Authrosied Signatory Place : Nashik Authrosied Signatory
For Treasury Use Only For Treasury Use Only For Treasury Use Only

Received Rs. (In words) Rupees (In figure) Received Rs. (In words) Rupees (In figure) Received Rs. (In words) Rupees (In figure)
Rs. Eight Thousand Three Hundred Fifty Only 8200.00 Rs. Eight Thousand Three Hundred Fifty Only 8200.00 Rs. Eight Thousand Three Hundred Fifty Only 8200.00
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Treasurer Accountant Treasury Officer / Agent of Manager Treasurer Accountant Treasury Officer / Agent of Manager Treasurer Accountant Treasury Officer / Agent of Manager