FORM NO. 3
EXPENDITURE TAX
[See rule 5 of Expenditure-tax Rules, 1987]
Return of aggregate of the payments received in respect
of chargeable expenditure
See section 8 of the Expenditure-tax Act, 1987 and rule 5 of the Expenditure-tax Rules, 1987

Please follow enclosed instructions
Use block letters only.
1. NAME OF ASSESSEE
ACKNOWLEDGEMENT
2. OFFICE ADDRESS
For Office use only
Receipt No. Date
PIN TELEPHONE Seal and Signature of Receiving
FAX, IF ANY Official
3. NAME AND ADDRESS OF THE HOTEL(S)
PIN TELEPHONE
FAX, IF ANY
4. PERMANENT ACCOUNT NUMBER
(if not applied for or not allotted, enclose Form 49A)
5. WARD/CIRCLE/SPL. RANGE
6. IF THERE IS CHANGE IN JURISDICTION, STATE OLD WARD/CIRCLE/SPL. RANGE
7. ASSESSMENT YEAR __
8. WHETHER ORIGINAL or Revised Return ?
If revised, Receipt No. and
date of filing original Return _ -
9. IS THIS YOUR FIRST RETURN ? Yes No
PART – I
STATEMENT OF CHARGEABLE EXPENDITURE (IN RS.)
GROSS CHARGEABLE EXPENDITURE INCURRED IN A HOTEL ETC. IN CONNECTION WITH THE PROVISION OF :
10. Any accommodation, residential or otherwise 159
11. Food or drinks by the hotel, whether at the hotel or outside 160
12. Food or drink by any other person at the hotel 161
13. Any accommodation in the hotel on hire or lease 162
14. Any other services at the hotel by the hotel by way of beauty parlour,
health club, swimming pool or other similar services
163
15. Any other services at the hotel by any other person by way of beauty
parlour, health club, swimming pool or other similar services
164
16. Total 165
PART-II
STATEMENT OF EXPENDITURE-TAX
A. Month wise breakup of chargeable Expenditure-tax collected and paid
Month
Chargeable
expenditure
Tax payable
on
Chargeable
expenditure
Expenditure Tax Interest payable
u/s 14
Interest u/s
14, if any,
paid
Date of
payment (DDMM-
YYYY)
(Attach
Challans)
Collected paid
1 2 3 4 5 6 7
April 970
May 971
June 972
July 973
Aug. 974
Sep. 975
Oct. 976
Nov. 977
Dec. 978
Jan. 979
Feb. 980
Mar. 981
Total 982
B. Total of Expenditure Tax and interest payable (total of column
A.2 + A.3)
983
C. Total of Expenditure Tax and interest paid (total of column
A.4 + A.5)
984
D. Balance payable, if any (B-C) 985
PART – III
OTHER SUMS NOT INCLUDED IN CHARGEABLE EXPENDITURE AND CLAIMED TO BE NOT TAXABLE
Particulars Amount (Rs.) Reasons for the claim
E. No. of documents/statements attached
Description In Figures In words
a. Challans
b. Others
Verification
I (name in full and in block letters) son/daughter of
being the (Designation) of (Name of the Hotel) solemnly declare that to the
best of my knowledge and belief, the information given in this return and the annexures and statements accompanying it is correct,
complete and truly stated and in accordance with the provisions of Expenditure-tax Act, 1987 in respect of expenditure chargeable for the year commencing on 1st day of April I further solmenly declare that during the said financial year, no other chargeable expenditure has been incurred in the hotel/restaurant/beauty parlour/health club/swimming pool or in respect of any other service to which the Act applies. I further declare that I am making this return in my capacity as

Date :
Place :
Assessee’s Signature
Before signing the verification, the signatory should satisfy himself that this return and the accompanying statements are correct and complete in all respects. Any person making a false statement, in this return, or the accompanying statements, shall be liable to prosecution under section 27 of the Expenditure-tax Act, 1987, and on conviction, be punishable with rigorous imprisonment for a term which shall not be less than three months but which may extend to seven years and with fine.