Refund Application

Government of Pakistan Department of Income Tax

Office of the ____________

The Commissioner __________ _______________________________________ _________________________________________________ (City)

Dear Sir,

I,

____________________________________________________________________

of

_______________________________________________________________________ hereby declare

a.

That my total income computed in accordance with the provisions of Income Tax Ordinance, 2001 (XLIV of 2001), during the year ending on ______________ being the income year for the assessment for the year ending on the ________________ amounted to Rs. _______________.

b.

That the total tax chargeable in respect of such total income is Rs. ______________.

c.

That the total amount of tax paid is Rs. ______________.

I, therefore, request that a refund of Rs. ________________ may be allowed to me.

Yours faithfully ______________________ Signature __________________________ NTN ______________________________ Address ___________________________

I hereby declare that I am resident/ non-resident* and that what is in this application is correct.

Date ___________________

* Delete whichever is in applicable.

Signature _________________