Revenue Tax

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ASSESMENT OF TAX

FORM A.I.T. 5-A (under rule 4 (3) (i) )

STATEMENT SHOWING CULTIVATED LAND OF OWNER SITUATED IN TWO OR MORE PATWAR CIRCLES IN THE PUNJAB, DURING THE TAX YEAR ………………

Name of owner (in block letters)    …………………………………….

Father’s /Husband’s Name  …………………………………….

National Identity Card No  . …………………………………….

Permanent address  …………………………………….

Address to which notices shall be sent  ……………………………………

PART I

Particulars of cultivated land held during Kharif season of the tax year…………

District / Patwar Khasra No.  Matured orchards____ other land______________

PART II

Choice of owner regarding

Collector of the Sub-Division] who should assess and collect the agricultural income tax

Name of Sub-Division] District

VERIFICATION

I solemnly affirm that to the best of my knowledge and belief the information given in this statement is accurate and complete in all respects.

Dated: _________________     Signature/Thumb impression of owner