APPLICATION FOR ASSESSMENT / RE-ASSESSMENT OF PROPERTY TAX

To,
The Panchayat Secretary,
Gram panchayat, _ _ __ _ _ _ _ _ _ _ _ _ _ _ __
_ _ _ _ _ _ _ _ _ _ (M), _ _ _ _ _ __ _ _ _ District

Sub:- Application for Assessment / Re-Assessment of Property Tax Request – Reg

Applicant Particulars
1 Applicant’s Surname :
2 Applicant’s Name :
3 Mobile Number :
3 Age :
4 Applicant’s Father /Mother/ Spouse :
Surname
Name
5 Address : District: Mandal: GP:
: H. No.: Street No./Road:
Area/Locality: PIN code:
6 Address of the premises seeking House(Residential)/Building (Non Res)
assessment
H.No Sy.No or Plot No.
No./Road: Area/Locality:
Any one of Neighbours H No. - -
7 Total Plot/Land Area (Sq. meters) L (length) B (breadth) =
8 Whether the construction is Completed Under construction

9 Type of Property Private Government

10 For Re- Assessment Assessment No H.NO

11 Tax Paid Up to
12 Building Permission No. and Date
13 Construction particulars
Date of completion
Type of Roof RCC, or RCC ordinary or AC/Zinc Sheet,
Or Bangalore Mangalore Tiles Country Tiles
Or Shabad Stones or Katcha
Floor Wise Plinth Area(Sq. meters),
Ground floor
1st floor
2nd floor
3rd floor
4th floor
5th Floor
Applicant Undertaking:
I hereby declare that all the information mentioned above is true to my knowledge.
In case of any discrepancies if arises I will be held responsible. Hence it is requested to assess my
property.

Date: Applicant’s Signature

List of Enclosures (Attested) for new Assessment
1. Building Permission with sanctioned plan
2. Copy of occupancy certificate
3. Present market Value Certificate
List of Enclosures (Attested) for Re- Assessment
1. Copy of sanctioned plan
2. Property tax receipt up-to-date paid
3. Present market Value Certificate
Office Use Only

I have verified the application and the enclosures and the application qualifies for further verification.
Thereby it is requested to collect the processing fees of Rs.______________

Application Number as per Online

Panchayat Secretary
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