FORM 3

[see Clause 9(C )(i)]

Application for Exemption of Luxury Tax/ Electricity Duty/

Entertainment Tax /Mandi Cess or Fee

(Under Rajasthan Investment Promotion Scheme 2003)

From

M/s____________________________________

_______________________________________

_______________________________________

To :Commissioner Indsutries

Rajasthan/

General Manager,

District Industries Centre,

…………………

Sub : Regarding Exemption of Luxury Tax/ Electricity Duty/ Entertainment Tax/ Mandi Cess or Fee.

I…………………… (Name of the applicant) S/o…………………. aged…………… hereby apply for grant of Exemption of Luxury Tax/ Electricity Duty/ Entertainment Tax/ Mandi Cess or Fee and submit as under .

1.	Name and complete address of the venture :
2.	Date of commencement of Service/ production/ commercial operation
3.	Exemption being sought for as per scheme	(a) Luxury Tax (100%) (b) Electricity Duty ( 50%) (c) Entertainment Tax (50) (d) Mandi Cess or Fee (50%)
4.	I hereby declare that I have fully understand the provisions of Rajasthan Investment Promotion Scheme 2003 and agree to comply with the same. In case of availing excess benefits or non compliance with the provisions of this Scheme, I undertake to repay whole of the amount actually availed under the scheme and shall also be liable to pay interest at the rate of 18% per annum on such amount.

Dated :……………………….. Signature of Applicant

Status

Name of the venture

Verification

I……………. hereby certify that the particulars stated above are true and correct and nothing has been concealed.

Signature of Applicant

With Status