Header Section

• Includes the title of the form such as “Professional Tax Declaration Form” or “Employee Declaration Form”.
  
• Displays the name and address of the employer or business entity.
  
• Contains the registration number (PTRC or PTEC) and financial year.
  
• May include the name of the applicable state or municipal authority.
  
• Often has space for logo or official seal of the employer.
  

Employee or Declarant Details

• Full name of the employee or self-declared individual.
  
• Designation or professional title.
  
• Permanent and current residential address.
  
• PAN number or Aadhaar number.
  
• Date of joining or commencement of profession.
  

Income and Deduction Declaration

• Declaration of gross monthly or annual income.
  
• Applicable professional tax slab selected based on declared income.
  
• Mention of whether professional tax has been deducted elsewhere.
  
• Tick-box for exemption claims, if any, along with reason.
  
• Declaration of truthfulness and accuracy of income details.
  

Employer or Declarant Confirmation

• Signature of the employee or self-employed person.
  
• Date and place of signing the declaration.
  
• Signature and seal of the employer or authorized signatory, where applicable.
  
• Name and designation of the person validating the declaration.
  
• Declaration of compliance with state professional tax laws.
  

Supporting Instructions and Checklist

• Guidelines for filling out the form properly.
  
• List of enclosures such as ID proof, income proof, or exemption documents.
  
• Note on applicable deadlines and where to submit the form.
  
• Mention of consequences for false declaration or concealment.
  
• Instructions for internal office use or acknowledgment stamp area.