ASSESSMENT -COLLECTION DEPARTMENT THE KOLKATA MUNICIPAL CORPORATION 5, S.N.BANERJEE ROAD KOLKATA - 700 013 Premises No. and Name of the Street/Road/Lane ....................... ............................... Ward No. ........ Assessee No ................ Name / Names of Owner / Occupier / Lessee / Lessor / Person Liable to Pay Tax (in full) .......................................... Mailing Address ..................................... .......................................... List of collected data / statement for revaluation (6-yearly) for G/R-2/05-06 related to Land/building/flat/commercial premises : (1) Status of Premises : (a) Area of total vacant land ............................... (b) Area of tank/pond within land ............................ (c) Area of total land including pond/tank ........................ (2) Details of Premises/Flat/Portion : (a) Measurement/Area of total land including building/flat ................... (b) Total area of premises/flat (on which the portion is situated) ................ (c) Date of completion of building/flat .......................... (3) Measurement of Premises/flat (in sq.ft.) : (a) Pacca premises/flat with R.C.C. Roof ......................... (b) Pacca building / premises / flat or covered with tin/asbestos/premises/flat built with bamboo ....................................... (4) No. of Storied .................................... (5) In case of flat/portion, nos. of floors or mother premises .................... Total no. of flat .......... Garage .......... Shop ........... Office ............. Showroom ...................... [For Inspector] (6) No. of flat & floor no. (in which the flat of assessee situated & flat no.) .............. (7) Floor wise description of assessee's flat/portion/premises (in sq.ft/sq.mt) :............. ......................................... - 2 - Description : Details of bedroom/drawing room/drawing-cum-dining room/lobby/kitchen/stair room/bathroom/ store/balcony/lift/stair/garage/car parking space .................... ......................................... ......................................... (1) No. of Area of Shop/Showroom/Office/Commercial portion including area .......... ....................................... (2) Assessee's rental status (Description in details) .................... Flat .......... Office ........... Shop ............ Factory ........ Garage ................ of If it is partly/fully rented. (a) No. of Tenants ............................... (b) Name of Tenants .............................. ...................................... (c) Details of Monthly Rent ............................ (d) Details of status of each Tenants : Floor No .............. Flat No. ................ ...................................... (10) For determination of Commercial Surcharge details of premises/Flat/portion .......... ........................................ Non-Residential/Commercial/Nursing Home/Bank/Hospital/Shop/Showroom/Factory/Guest House/ Cinema Hall/Educational Centre/Ceremonial House. Status and Name in details (including Statement) ...................... ......................................... ......................................... ......................................... ............... ................ Full Name of Owner / Assessee Full Name of Inspector with signature
