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THE MAHARASHTRA STATE TAX ON PROFESSIONS TRADES, CALLINGS AND EMPLOYMENTS RULES, 1975. - FORMS
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FORM XIV A

[See Rule 22 (1)]

Application for obtaining authorisation for working as a Recovery Agent under the Maharashtra State Tax on Professions, Trades, Callings and Employments Act 1975.

To

The Commissioner of Profession Tax,

Maharashtra State, Mumbai.

Sir,

I the undersigned Shri / Smt. .............................................................................................................................
  (Surname) (Name) (Father's / Husband's Name)

hereby apply for obtaining authorisation for working as a recovery agent undergo Maharashtra State Tax on Professions, Trades, Callings, and Employment Act, 1975 (Mah. XVI of 1975).

My particulars are as under. -

(1) Name in Full  
(2) Address :-  
  (a) Flat / Block No. / Room No. ...............
  (b) Road / Street / Lane ...............
  (c) Area / Locality ...............
  (d) Town / City / District ...............
  (e) Pin Code. ...............
  (f) Telephone No. (if any , with STD Code.) ...............
(2A) Educational Qualification from S.S.C. onwards:-
Examination Board/University Years of Passing Percentage of Marks Remarks
(1) (2) (3) (4) (5)
         
 
(2B) (a) Whether registered with local Employment Exchange
(b) If yes, the Registration No. ................................
(3) Experience of working as Small Saving Agent.

Details of Registration /Enrolment , etc., with the Director of Small Savings.

...............
(4) Enrolment No. under the Maharashtra State Tax on Professions, Trades, Callings and Employments Act. 1975 (Mah. XVI of 1975). ...............
(5) Permanent Account No. Or GIR No. under the Indian Income Tax Act, 1961.  
(6) Details of Security furnished . ...............

I hereby state that I shall follow the provisions of the law and rules framed by the Government and the instructions given by the Profession Tax Authorities, which discharging my duties as a recovery agent.

Place :  
Date : Signature and Name in full.

VERIFICATION

I, Shri / Smt. ................................................ hereby declare the whatever is stated above is true to the best of my knowledge and belief.

Verified this ................................... (date) day of ...................... (month) .......................... (year), at .......................... (place).

   
  Signature and Name in full.

.........................................................................................................................................................................

Received application for authorization to work as recovery agent from Shri / Smt. ............................. on ...................... (date ) at .......................... ( place )

Office Stamp and Signature of the Receiver.