KARNATAKA TAX ON PROFESSIONS, TRADES, CALLINGS AND EMPLOYMENTS RULES, 1976 - FORMS
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Body

FORM 5-A

[See Rule 11-A]

Statement of tax payable by employer under sub-section (1) of Section 6-A.

1. Amount of tax payable for the month or quarter ending on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Name of the Emoloyer. . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. Address . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Registration Certificate No. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. Number of employers during the mont or quarter in respect of whom the tax is payable is as under:-

Employees whose monthly salary or wages of both are		Number of employees	Rate of Tax per month	Amount of Tax deducted
(1)		(2)	(3)	(4)
(a)	Less than Rs.3000		Exempted
(b)	Not less than Rs.3,000 but less than Rs.5,000		Exempted
(c)	Not less than Rs.5,000 but less than Rs.8,000		Exempted
(d)	Not less than Rs.8,000 but less than Rs.10,000		Exempted
(e)	Not less than Rs.10,000 but less than Rs.15,000		Rs.150.00
(f)	Not less than Rs.15,000 and above		Rs.200.00
Amount paid under Challan No. . . . . . . . . . . . . . . . . . . .dated. . . . . . . . . . . . .

I certify that all the employees who are liable to pay the tax in my employ during the period of statement have been covered by the foregoing pacrticulars. I also certify that the necessary revision in the amount of tax deductable from the salary or wages of the employees on account of variation in the salary or wages earned by them has been made where necessary.

I, Shri. . . . . . . . . . . . . . . . . . . . . . . .solemnly declare that the above statements are true to the best of my knowledge and belief.

Place:	Signature
	(Employer)
Date:	Status.