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Lo;a vkdyu lEifÙkdj QkeZ ¼o"kZ 2010&11 ls 2013&14 rd½ Self Assessment Property Tax Form (2010-11 to 2013-14)
Permanent Property ID: 83C95U54 Ward No.: 6 Zone: City Locality: Thakurdwara
Owner/Occupier Name: Thakur Dwara Trust Property Address: Thakurdwara, Ambala City 134,003
.

A. B. C. D. E. F. G H. I. J.
Total Plot Area Building Use Special Category Floor (Basement Floor wise Self Occupied/ Rate for calculation Annual Annual Fire tax Total Annual
(Sq.Yds.) /GF/1F/ 2F… Carpet area Rented of Property Tax Property Tax* @ 10% of Property Tax Property Tax(H+I)
(Sq. Ft.) [only on non
resl.property]
500 WOR Mandir 1F 2,100 Self 100% Rebate 0 0 0
- WOR Mandir GF 2,100 Self 100% Rebate 0 0 0
- Coml Shop GF 1,860 Rented 36 x 1.25 9,270 927 10,197
TOTAL - - - 6,060 - - 9,270 927 10,197
1. 2. 3. 4. 5. 6. 7.
Old House Tax Arrear before 2010-11 Amount of the Property Amount of the Property Amount of the Property Amount of the Property Grand Total
Property No. Tax for the Year 2010-11 Tax for the Year 2011-12 Tax for the Year 2012-13 Tax for the Year 2013-14 (3+4+5+6)
(after rebate 30%) (after rebate 30%) (after rebate 30%) (after rebate 10%)
7,137 7,137 7,137 9,177 30,588

8. 9. 10. 11.
Last payment details (only for the year 2010-11 to 2013-14) Balance to be paid by assessee Balance to be adjusted by MCA Remarks
Amount paid Receipt No. & Date (7-8) (8-7)

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It is certified that the particulars filled in this form are true and correct to the best of my knowledge and nothing has been concealed. I further declare that I shall be responsible for any discrepancy as per provision made in property
tax notification dated 11-10-2013 and Haryana Municipal Corporation Act 1994. I am authorized to sign self assessment property tax form.

Name of the Owner/Occupier Owner's/Occupier's Phone No./Mobile No. & Email ID Date Signature

*Formula as per Government policy @ 11-10-2013.

# PAYMENT: The owner / occupier can deposit the payment of property tax at the office of Municipal Corporation Ambala at Ambala City, Jagadhari Gate-134003 and Ambala Cantt., Near Parshuram Chowk – 133001, through
cash or an A/c payee cheque or a demand draft in favour of “Commissioner Municipal Corporation Ambala”. No cheque will be accepted until the "owner name”, “phone number", "property ID" & "assessment year" is
mentioned on the back of cheque.
# PLEASE IGNORE IF ALREADY PAID