FORM NO. 57
[See rule 117B]
Certificate under section 222 or 223 of the Income-tax Act, 1961
Notice of demand under rule 2 of the Second Schedule to the Income-Tax Act, 1961

Office of the TRO
Dated the
To
(GIR/PAN)
1. This is to certify that a sum of Rs. _______________ has become due from you on _________________________ in the status of _______________details of which are given on the reverse. Whereas a certificate bearing Serial Number_____________________ dated _____________ had been forwarded by the Tax Recovery Officer, ___________________________________ [name of the place], for the recovery of the sum of Rs.___________________ details of which are given on the reverse [and the said Tax Recovery Officer has sent a certified copy of the said certificate to the undersigned under section 223(2) of the Income-tax Act, 1961], specifying a sum of Rs. ___________ which is to be recovered from you.
2. You are hereby directed to pay the above sum within 15 days of the receipt of this notice failing which the recovery shall be made in accordance with the provisions of section 222 to section 232 of the Income-tax Act, 1961, and the Second Schedule to the said Act and the rules made there under.
3. In addition to the sums aforesaid, you will also be liable for,-
(a) such interest as is payable in accordance with section 220(2) of the said Act for the period commencing immediately after the issue of this notice;
(b) all costs, charges and expenses incurred in respect of the services of this notice and of warrants and other processes and all other proceedings taken for realising the arrears.
SEAL ______________________________
Tax Recovery Officer
Score out whichever paragraph is not applicable.
DETAILS OF AMOUNT IN ARREARS
Rupees
Regular Advance Provisional Asst. year
1. Income-tax
2. Surcharge
3. Additional tax u/s 143
4. Penalty u/s ______________
5. Interest u/s ______________
6. Fine u/s 131
7. Any other sum (give details)
8. Interest u/s 220(2) from the day when amount became due
9. Total