Form No. ... Cost Rs. 5/ APPLLICATION / DECLARATION For the Purpose of Assessment of Property Tax UNDER SECTION 114 (3) of A.M.C. ACT. 1990 Circle No. .... Ward No. ...... (Page -2) Description of the Property: 1. Location details: (a) House / Plot / Holding No. __________________________________________ (b) Name of the lane / road / street _______________________________________ (c) Ward No. ___________________ (d) Pin Code ____________________ 2. Land (Vacant / In process of construction): (a) Total area of land __________________ Portion vacant, in any ______________ (b) Whether leasehold / freehold __________________________________________ (c) Consideration amount of land paid ______________________________________ (d) Date of taking over possession of land ___________________________________ (e) If in process of construction, date of start of construction ____________________ (f) Building to used for __________________________ Residential / Non-residential. 3. Built up area __________________________________________________________ 4. Apartment / Flat / Part of Building-Residential Non-Residential Portion Portion (a) Covered area of flat _____________ _____________ (b) Consideration amount of flat paid _____________ _____________ (c) Date of taking over possession _____________ _____________ (d) Covered area in self possession _____________ _____________ (e) Covered area on rent _____________ _____________ 5. Details of Rent: (a) Name of tenants ______________________________________________________ (If the space is not sufficient additional sheets may be used) (b) Monthly actual rent received __________________________________________ (c) Rent for fixtures & fittings ____________________________________________ (d) Date of tenancy ____________________________________________________ (Page -3) Building: 6. Constructed by the owner of ancestral __________________________________________ Residential Non-Residential (a) Area of Land ______________ ______________ (b) Cost of Land ______________ ______________ (c) Covered area of construction ______________ ______________ (d) Cost of construction ______________ ______________ (e) Date of completion of construction/ ______________ ______________ building/ flat (f) Cost of addition & improvement, if any ______________ ______________ (g) Covered area if self use ______________ ______________ (h) Covered are on rent ______________ ______________ (i) Covered area on rent ______________ ______________ (j) No. of Storey (Whether One/ Two ______________ ______________ Storied etc.) 7. Type of construction of the building (Please specify) Construction ______________ Pucca/ Semi-Pucca/Kutcha/Others Floor ______________ Kutcha/Cement/Mosaic/Marble/Others Walls ______________ Kutcha/Cement Plaster/Lime Wash/Plastic Paints/Others Roof ______________ Thatched/Tiled Shed/Tin Shed/Rcc/Others 8. Approximate distance from the main road (a) Name of the main road __________________________________________________ (b) Width of the nearest pucca road ___________________________________________ Name ___________________________________________ (c) Distance from this pucca road _____________________________________________ (d) Width of the road in front of the property ____________________________________ Whether (d) is in - AMC/ADDA/PWD/Common Passage/Others (specify) 9. Description of Building- (Page -4) 10. Use of Building/Flat- Residential/Non-Residential 10-A. Lift/A.C. (a) Whether the building is centrally A.C. Yes/ No (b) Whether flats/rooms are A.C. Yes/ No (c) If yes, cost of installation _____________________________ (d) Lift Yes/ No (e) Cost of installation of Lift ____________________________ 11. Value of the property as determined by the Registration Office (Government of West Bengal) In case any instrument is executed ______________________________________ 12. Detailed Mailing Address in which P.D. bills will be sent with Pin Code- I/ We ______________________________________________________________ son/ daughter/ wife of _____________________________________________________________ declare that the above information is correct to the best of my/ our knowledge and belief. Date : ________________________ ______________________________ Signature of the persons liable to pay Address _______________________
