FORM III

[See rule 12]

Return of tax payable by registered employers under the West Bengal State Tax on
Professions, Trades, Callings and Employments Act, 1979
(Please type or use capital letters/figures while furnishing the following information.)
Period
From ……. to .........
(a) Registration Certification No.

[In the first three boxes, please insert zone prefix, e.g., RCN, RCE, etc.]
(b) Enrolment Certificate No.

[In the first three boxes, please insert zone prefix, e.g., ECN, ECE, etc.]
(c) Name of the employer : Shri/Sm. .............................................
(d) Trade Name :.............................................................
(e) Address (including Room No., Floor No., Police Station, Sub-division
and Postal Index No., i.e. PIN) :.............................................................
(f) Telephone No. (if any) :
(g) E-mail I.D. (if any) :
(h) Website (if any) :
(i) Tax payable for the *quarter/*year ......
Tax paid for the *quarter/*year ......
Tax payable/paid in excess for the *quarter/*year ......
(j) Interest payable for the *quarter/*year ......
Interest paid for the *quarter/*year ......
Interest payable/paid in excess for the *quarter/*year ......
Summary of payments made for the quarter/year

Month Tax (Rs.) Challan Date of Name of Interest Challan Date of Name of
No. payment bank (in Rs.) No. payment bank

April
May
June
July
August
September
October
November
December
January
February
March
Total payment for the year
A separate statement showing the amount of tax deducted in accordance with the
rates of tax specified in the Schedule to the Act in respect of the number of employees
belonging to each salary-s1ab as specified in column (2) against serial No.1 of the said
Schedule is furnished herewith.
The above statements are true to the best of my knowledge and belief.
Place …………… Signature.....................
Date............. …… Status ..........................
*Strike out whichever is not applicable. [Please see the reverse]
 Employees whose monthly Number of Employees Rate of tax Amount of tax deducted Total
salaries or wages are MONTHS* MONTHS*
Apr May June July Aug Sep Oct Nov Dee Jan Feb Mar Apr May June July Aug Sep Oct Nov Dee Jan Feb Mar

(i) Rs. 3000 or less Nil

(ii) Rs. 3001 -- below 5001 Rs. 30 per month
iii) Rs. 5001 " " 6001 Rs. 40 " "
(iv) Rs. 6001 " " 7001 Rs. 45 " "
(v) Rs. 7001 " " 8001 Rs. 50 " "
(vi) Rs. 8001 " " 9001 Rs. 90 " "
(vii) Rs. 9001 " " 15001 Rs.110 " "
(viii) Rs.15001 " " 25001 Rs.130 " "
(ix) Rs. 25001 " " 40001 Rs.150 " "
(x) Rs.40001 and above Rs.200 " "
GRAND TOTAL

*In case of quarterly/annual returns, particulars in respect of the relevant months of every quarter/year only are required to be furnished.

Signature .........................
(with date)
Status .......................... ...