प्रधान मुख्य आयकर आयुक्त मध्य प्रदेश ,छत्तीसगढ़
PRINCIPAL CHIEF COMMISSIONER OF INCOME TAX Madhya Pradesh & Chhattisgarh

Fill This Form To Avail Madhya Pradesh & Chhattisgarh Income Tax Free Legal Services Cell (MPCGITFLSC)

First Name
Middle Name
Last Name
PAN
TAN (if applicable)
Flat/Door/Block No.
Name of Premises/Building/Village
Road/Street/post office
Area/Locality
Town/city/district
State (select)
Pin Code
Phone No. with STD code/Mobile No.
E-mail Id
Ctegory
Gender
Physical Handicap
Senior Citizen
Annual Income
Eligibility Criterion for the Person willing to avail Free Income Tax legal Services
Having annual income of less than R. 5.00.000
member of a Scheduled Caste or Scheduled Tribe
A woman or a child or a widow or a Senior Citizen (In specific cases)
A person of disability as defined in clause (i) of section 2 of the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full participation) Act 1995 (1 of 1996)
An industrial workman or salaried employee of any organization or retired salaried employee including serving and retired personnel from armed forces
A tax exempt organization or Society or Trust
A religious or charitable organization
a loss making assessee or BIFR company
Any other person(s) considered by the executive committee on the ground of hardship.

Section and subsection of the Incometax Act, 1961 Under Which the action is required
Brief of Issue
Ammount Involved (In Rs)
Total Refund/Demand (In Rs)
If Matter is relates to penalty
Ammount Of Panalty (In Rs)
Section under which penalty was imposed
Status of return field by the applicant for the concrened assessment year in connection with which hte application is filed ,weather tax due on income has been paid in full (if any due)
Acnologement Number
Date of Filing
Total tax paid
Weather an ammount equal to the account of advancre tax as per section 249(4)(b) of the Income-tax Act, 1961 has been paid (where applicable)
BSR Code
Date of Payment
SI. No.
Ammount
Weather there is dealy in filing appeal


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