7/20/23, 11:14 AM pt.kar.nic.in/Form4_A?

rcn=1024728562&id=499787

FORM 4-A
[See Rule 19(3-A)]

I. Return to be furnished by an enrolled person under section 10(1) of the Karnataka Tax on Professions, Trades,
Callings and Emploments Act, 1976.
1. Return for the year ending on: 2023-2024

2. Name of the Enrolled person: MAXINIQUE SOLUTION PRIVATE LIMITED

3. Full address and Telephone No: Vishveswariah 80 Feet Road, BTM layoutNo.2, 2nd Floor, Booth
no.30

4. GSTIN 29AAOCM0228K1Z5

5. Profession, Trade etc. (specify) GST Dealers

II. Details of exemption claimed in respect of any partners who have paid tax in other firms or exempt senior citizens or in
any other capacity:
1. Name of the person: NA

2. Full address and Telephone No.: NA

3. Profession, Trade etc. (specify): NA

4. GSTIN NA

5. PT Demand entered by the Dealer: 2500

6. PT Additional Demand raised by the Officer:

7. Office in which the payment is made: PTO-03-Bengaluru

I   MAXINIQUE SOLUTION PRIVATE LIMITED certify that that the information furnished above is true to the best of my
knowledge and belief.

Date: 20/07/2023 Signature: .....................

Place: PTO-03-Bengaluru Name and designation: ..................

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