Form No.

A-75-1

APPLICATION FOR RECONSIDERATION OF VALUATION DUE TO CHANGE OF OCCUPANCY

(When tenant/lessee moves out)

Please use block letters only and fill in all relevant information. Attach
separate sheets wherever space is inadequate.
Please quote your Assessee No. for all Correspondences.
Please attach a copy of the last paid Property Tax Bill.
The downloadable form A-75-1 is available on the site
www.kolkatamycity.com

ACKNOWLEDGEMENT
For Office use only
Receipt No.
.

Date
..

Seal and Signature of

Receiving Official
1.

Name of applicant

2.

Assessee number

3.

Ward number

4.

Present Address
(Flat
No./Room
No./House
No./Suite
No./Premises No., Floor
No., Road,
Locality,
Prominent
landmark,
Village/Town, District,
State/Union territory, in
that order)

5.

Address
of
communication (if not
same as above)

6.

Telephone: (i) Office

(iii) Mobile

7.

e-mail ID

8.

Measurement of Premise (in sq.ft.):

(ii) Residence

Total land area including the building/flat

Total covered area on which the premises/flat/portion is situated

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Floor/carpet area of the flat1

Area of closed garage / car parking space
Area of open garage / car parking space
9.

Details of tenant who has moved out (Please attach copies of all agreements)
Name of tenant

Details of Monthly Rent (in Rupees)

Area occupied by the above tenant (sq. ft.)
Floor occupied by the above tenant
Date of effect of change in occupancy

Please tick the appropriate nature of use

RESIDENTIAL
COMMERCIAL

10.

Whether any portion of the above premises is being used for commercial purposes (Please tick the
appropriate box.)

YES

NO

YES

NO

If YES, area of such portion (sq. ft.)

Please indicate the specific nature of commercial use
(e.g. sweet shop, health club etc.)
11.

Whether any other portion of the above premises is already tenanted / sold (Please tick the
appropriate box.)
If YES, please provide details of all such tenanted/sold out portions below:
Name of tenant/transferee
Details of Monthly
Details of status of each
Rent (in Rupees)
Tenant (Floor No, Flat No,
Area occupied in sq. ft.)

Nature of use

1)

2)

3)

Super built-up area will be assumed to be 25% over and above the Carpet area

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UNDERTAKING
I/We agree, declare and undertake that the premises/flat on the .floor of the premises is not intended to be
let out. In case of any subsequent change in use or nature of use of the premises or portion of the premises
referred to above, I/We shall inform in writing to the Municipal Commissioner within fifteen days of such
change and also submit a return in accordance with section 182 of the KMC Act, 1980.
In case of omission to inform the Municipal Commissioner as aforesaid the Municipal Commissioner
shall be at liberty to revise the assessment of the premises or portion thereof in accordance with section 180 read
with section 192 of the KMC Act, 1980, with effect from the date of this declaration.

Signature of the Owner/Lessee/Hut

Owner/Person liable to pay tax

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