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MC ________________
Proforma for Self Assessment of Property Tax
I hereby furnish the following details to the Municipal Corporation/ Council/ Committee __________ for the assessment year
_________to ________ as an obligation towards the self assessment of Property Tax as per the provisions of the Haryana
Municipal Corporation Act, 1994/Haryana Municipal Act, 1973 and Property Tax notifications no.S.O.
85/HA.16/1994/S87/2013 and S.O. 86/HA.24/1973/S.69.2013 dated 11th October 2013.
S#
1
Property Address
Property/Flat/ House
No.
Sector/ Colony Name
Ward No.
City
2
3
4
5
6
Pin Code
If Yes, Sub-Type
House
If Yes, Sub-Type
Shop
If Yes, Sub-Type
Comm.
7. Special Category
If Yes, No. of Beds
Flat
Commercial Space
Non Comm.
If Yes, Select Sub-Type below
Educational
b. Marriage Palace
a. Private Hospital
d. Cinema Hall: Stand Alone
In Malls/ Multiplex
e. Storage Godown
g. Grain Market/ Subzi mandi/ Timber Market/ Sub-Market Yardh. Hotel: Upto 3 star
Notified by HSAMB: Shop
Booth
Above 3 star
k. Other Institutions like stand-alone hostel, paying guest house etc
8
9
11
13
14
16
17
18
No. of Floors
Name of Owner / Name of
Organization
Contact No. (i)Landline
Basement
G.F.
(ii) Mobile
ii
iii
iv
20
F.F
S.F
10. Name of
Contact Person
+91 -
T.F
12. Email:
Property Details
Plot Status
Vacant
Constructed
Size of Plot/ Land (Sq. Yd)
Carpet Area (in case of Flats,
Commercial Spaces, Spl. Cat.) (Sq. ft.)
Rented Area (for Comm. Only)
(Sq. ft/Sq. yd)
19
i
c. Bank
f. Restaurant
i. Club
j. Private Office Building
Self
Rented
Rebate Clause
Religious properties
Alm houses
Cremation/ Burial ground
Orphanage
Owner is a Defence/ Paramilitary Force personnel
Family of Deceased Soldiers/ Ex-Servicemen
Municipal buildings
Central or State govt. office
Dharamshala
Public Sector Undertaking
Ex-Service/ Paramilitary Force personnel or his/ her spouse
Ex-Central Paramilitary Force personnel
Self-assessed Tax
Floor Wise Property Tax Details
21
Floor
Basement
ii
Ground Floor
Iii
First Floor
iv
Second Floor
Third Floor
22
(Rs.)
Property Tax on the floor
23
Assessment Year
2010-11
ii
2011-12
iii
2012-13
iv
2013-14
General Rebate
Special Rebate
24
25
Total Assessments
Period of Settlement of
from
to
26. Arrear Amount
Arrears (prior to Year 2009-10)
27 Fire Tax (@10% of property tax other than
residential properties)
28 Tax if already paid G8 No. and Date
Balance to be Paid/
(please attach proof)
Adjusted
29 Total Amount
Payable
DECLARATION: It is certified that the particulars filled in this form are true and correct to the best of my knowledge, nothing
has been concealed. I further declare that I shall be responsible for discrepancy as per provision made in the new property
tax notification dated 11.10.2103 and Haryana Municipal Act, 1973/ Haryana Municipal Corporation Act, 1994.
Place:
Date : .