For Payments from April 2007 onwards G.A.R.

–7 Performa for Service Tax Payment (Receipt & Payment Rules 26)

Full Name DRS NORTHEX EYE INSTITUTE (P) LTD.

Complete Address C-9/34, 1ST FLOOR, SECTOR-7,, ROHINI

DELHI, DELHI

Telephone No. 27054949 Pin Code 110085

Assessee Code No. AABCD7553KSD001

Commissionerate Name SERVICE TAX - DELHI

Commissionerate Code SE Division Code 01 Range Code 07

Account Code of Duty / Cess Amount Tendered in Rupees

00440598 3045

00440298 61 RECEIVING BANK BRANCH STAMP

00440426 30

Total 3136

Rupees (In words) Three Thousand One Hundred Thirty Six Only. Tendered by

Cash / Cheque / Draft / Pay Order No. Date Drawn on

Signature of the Tenderer With Date Date

Account Code of Duty / Cess Amount Tendered in Rupees TAX PAYER’S COUNTERFOIL

00440598 3045

00440298 61 RECEIVING BANK BRANCH STAMP

00440426 30

Total 3136

Received from Assessee Code No. AABCD7553KSD001

Rupees (In words) Three Thousand One Hundred Thirty Six Only.

Cash / Cheque / Draft / Pay Order No. Date Drawn on

on account of Union Service Tax as detailed in this taxpayer’s counterfoil and on stamp affixed and signed therein.
For the month Aug 2010 DRS NORTHEX EYE INSTITUTE (P) LTD. Service Tax on HEALTH SERVICES

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