1[FORM IA
[See Rule 4(2)]
NAME OF THE BOARD

1. Ins by G.S.R. 311 (E), dt. 28.2.1992, published in Gazette of India, Part II 3(i), dt. 5.3.1992
No.                                                                                                                  Dated:
Notice under Section 5(2) of the Water (Prevention and Control of Pollution) Cess Act, 1977) (36 of 1977)
To
Name and Address of the Consumer:
Assessment period:
Whereas you were required to furnish a return as provided under subsection (1) of Section 5 of the Water (Prevention & Control of Pollution) Cess Act, 1977 (36 of 1977) read with the sub-rule (1) of Rule 4 of the Water (Prevention and Control of Pollution) Cess Rules, 1978, by the 5th of
And whereas you have failed to furnish the return by the said date:
Now, therefore, you are hereby called upon to furnish the return within 7 days from the date of receipt of this Notice.
In case no return is received within the said period of 7 days, action will be taken for making assessment as per sub-section (I A) of Section 6 of the aforesaid Act, ex-parte, besides initiating any other legal action as per law against you.
Issuing authority
Place:                                                                           Name:…………………….
Date:                                                                            Address:.........................….