FORM 5

See Rule (11)

Return of tax payable by employer under Sub-section (1) of Section 6 of the Karnataka Tax on
1.Return of tax payable for the month ending April-2010
2.Name of the Employer: dgh
3.Address: prathanaShimoga

4.Registration Certificate No.712221 yytr

No of Employees during the month in respect of whom the tax payable is as

SL. Employees whose Monthly salaries or wages or No. of Employees Rate of Tax per Amount of tax
both are month

1 Rs. 10000 to Rs. 14999 0 0 0

2 Rs. 15000 above 0 0 0

Grand Total 0 0

Amount Paid

Balance 0

Amount paid under challan/Ch.N0./ 17/12/2010 Dated: 2010-12-17

I certify that all the employees who are liable to pay the tax in my emply uring the period of return
I Sri S.GuruRaj solemnly declare that the above statement are true to the best of my knowledge and belief.
Place: gfff
Date: 17/12/2010