FORM - 3 [See rule 3(1) (c)] Monthly Abstract of Collection and Remittance of Luxury Tax Name of Hotel: __________________________________________________ Month Total No. Total charges Total Luxury tax paid to Governament Remarks of guest recovered for residential accommodation luxury tax collected Amount Chalan No. Date Balance 1 2 3 4 5 6 7 8 Signature.... Name.... Designation... Date:... I, the above named Shri ............. residing at ............ ......... do hereby solemnly affirm and say that the contents of the above return are true to the best of my information and belief. Place:.. Date:... Signature of hotelier
