FORM - 4 A

[See rule 4-A]

Application to exercise option

To,

The Profession Tax Assessing Authority

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

I...............(Name) of..............(Address) holding registration certificate No............date............ under the M.P. Vritti Kar Adhiniyam, 1995 liable to pay tax according to serial number 3 to 10 of the Schedule appended to the said Adhiniyam, hereby opt to pay on the annual income as specified in column (2) against serial number 2 of the said schedule in lieu of the tax payable by me, for the period............

Place................

Date.................