T. R. FORM NO.

12
(FORM IV of WB State Tax on Professions, etc. Act, 1979)
[See sub-rule (1) of T.R. 4.080]
Statement of recovery under the West Bengal State Tax on Professions, Trades, Callings and
Employments Act, 1979 (West Bengal Act VI of 1979)

Name of the Office : ADDITIONAL DISTRICT SUB-REGISTRAR SAGARDIGHI

D.D.O.Code MUCIGR001 Bill No. 05 Date: 21/05/2024

Token No. Date : T.V. No. Date:

Pay Bill for the Month of : May, Year 2024

Salary Head of Account : 18-2030-03-001-002-01-V

Head of Account Code : 0028-00-107-001-03

Sl. No. Unique ID No. Name Amount Recovered (Rs.)
1 1987005433 DIBAKAR KAYAL 200
2 2015008604 MD. JOHIRUL ISLAM 150
3 2015003521 SOUMITRA SARKAR 200
Total Rs. ( in words) Five Hundred Fifty only Total (Rs) 550

BILL CLERK / ACCOUNTANT SIGNATURE OF D.D.O.

Printed by : SOUMITRA SARKAR Print Date & Time 21/05/2024 7.57 PM