FORM    III
[See Rule 10]
Certificate to be Furnished by a Person to his Employer

I,__________________________________________________________________________(Name)  _________________________________________________________________________________ _______________________________ (Address) hereby certify that I am engaged in the *profession/ trade / calling of _______________________________________________________ specified in the___________________________________ Schedule I appended to the Andhra Pradesh Tax on Professions, Trades, Callings and Employments Act, 1987 and that the rate of tax payable by me under the said entry, namely Rs. ________________ Per annum is more than the rate of tax payable by me under Entry I in the said schedule in respect of employment with, _________________________________________________________________________________ (Name of the employer) ______________________________________________________________________________________________________(his address)

I also certify *I shall get myself enrolled and shall pay the Tax / I have got myself enrolled under enrolment certificate.

No ___________________________ dated _____________ and I have paid the *tax/shall pay the tax.

Place  :
Date   :
                                                                                                         (Signature)

Note : *Strike out whichever is not applicable