* egRoiw.kZ % Ñi;k pkyku Hkjus ls igys fVIi.

Ii.kh ihNs ns[ksa A ,dy izfr ¼{ks-ys-vf/kdkjh ds ikl Hkstus ds fy,½ / Single Copy (to be sent to the ZAO)
Important: Please see notes overleaf before filling up the challan.

mi;qDr dj (,d ij fu'kku yxkosa) @ Tax Applicable (Tick One) * pkyku la- @ vkbZ
Vh ,u ,l
(0020) fuxe dj@ CORPORATION TAX (0032) /udj@WEALTH TAX CHALLAN NO. /
ITNS
(0021) vk;dj@INCOME TAX
280
LFkk;h ys[kk la[;k @ Permanent Account Number fu/kkZj.k o"kZ @ Assessment Year
–

iwjk uke @ Full Name

iwjk irk] uxj vkSj jkT; lfgr @ Complete Address with City & State

Hkqxrku funsZ'ku (,d ij fu'kku yxkosa) / Type of Payment (Tick One)

vfrdj @ Surtax (102)
vfxze dj @ Advance Tax (100) ns'kh daifu;ksa ds forfjr ykHk ij dj @ Tax on Distributed
Profits of Domestic Companies (106)
Lo;a fu/kZj.k dj @ Self Assessment Tax (300)
;wfuV /kjdksa dks forfjr vk; ij dj @
fu;fer fu/kZj.k ij dj @ Tax on Regular Assessment (400) Tax on Distributed Income to Unit Holders (107)

Hkqxrku dk fooj.k @ DETAILS OF PAYMENTS izkIrdrkZ cSad esa iz;ksx ds fy;s

jkf'k (dsoy :- esa) @ Amount (in Rs. Only)
FOR USE IN RECEIVING BANK
dj @ Tax [kkrs ls MschV @ psd ds ØsfMV dh rkjh[k
Debit to A/c / Cheque credited on
vf/Hkkj @ Surcharge

C;kt @ Interest rk- / DD ek- / MM o"kZ / YY

'kkfLr @ Penalty cSad dh eksgj ds fy, LFkku

SPACE FOR BANK SEAL
vU; @ Others

tksM+ @ Total
tksM+ ('kCnksa esa) @ Total (in words)
djksM @ CRORES yk[k @ LACS
gtkj @ lSdM+k @ ngkbZ @ TENS
THOUSANDS
bdkbZ @ UNITS
HUNDREDS

udn @ [kkrs ls MschV @ psd la- fnukad

Paid in Cash/ Debit to A/c /Cheque No. Dated

vnkdrkZ cSad @ Drawn on

(cSad ,oa 'kk[kk dk uke) @ (Name of the Bank and Branch)
}kjk tek fd;k A
fnukad @ Date : tek djus okys O;fDr ds gLrk{kj
Signature of person making payment
;gka ls dkVs a@ Tear Off
(djnkrk }kjk Hkjk tk,xk)
djnkrk dk izfri.kZ @ Taxpayers Counterfoil (To be filled up by tax payer) cSad dh eksgj ds fy, LFkku
LFkk;h ys[kk la- @ PAN SPACE FOR BANK SEAL

Received from
(uke) @ (Name)
ls udn@[kkrs ls MschV @ psd la- :-
Cash/ Debit to A/c /Cheque No. for Rs.

#- ('kCnks esa)
Rs. (in words)

vnkdrkZ cSad @ Drawn on

(cSad ,oa 'kk[kk dk uke) @ (Name of the Bank and Branch)
}kjk
on account of fuxe@Corporation
/ vk;@ Income
/ /u@ Wealth
(tks ykxw uk gks mls dkV nsa) @ (Strike out whichever is not applicable)
dj@Tax

ds :i esa fu/kZj.k o"kZ @ for the Assessment Year – ds fy, izkIr gqvk
 *fVIi.kh@NOTES

1. Ñi;k gj izdkj ds Hkqxrku ds fy, vyx&vyx pkyku dk iz;ksx djsa A

Please use a separate challan for each type of payment.

2. Ñi;k uksV djsa fd vkidk LFkk;h ys[kk la[;k n'kkZuk vfuok;Z gS A

Please note that quoting your Permanent Account Number (PAN) is mandatory.

3. Ñi;k uksV djsa fd vk;dj vf/fu;e] 1961 dh /kjk 272 ch ds vuqlkj >wBk LFkk;h ys[kk
la[;k n'kkZus ij 10000@& :i;s ds naM dh O;oLFkk gS A
Please note that quoting false PAN may attract a penalty of Rs. 10,000/- as per section
272B of I.T. Act, 1961.

Ñi;k bl pkyku dk iz;ksx iwoZ i`"B ij n'kkZ;sa djksa (Hkqxrku funsZ'ku) dks tek djkus ds
fy, djsa A Ñi;k bl pkyku dk iz;ksx Ïksr ij dkVs x, dj (Vh Mh ,l) dks tek djkus
ds fy, ugha djsa A
PLEASE USE THIS CHALLAN FOR DEPOSITING TAXES (TYPES OF
PAYMENT) MENTIONED OVERLEAF. KINDLY DO NOT USE THIS
CHALLAN FOR DEPOSITING TAX DEDUCTION AT SOURCE (TDS)

cSad dkmaVj NksMus ls igys tk¡p djsa fd vkids izfri.kZ ij cSad 'kk[kk }kjk tkjh ikorh esa
cSad dh 'kk[kk dk uke] cSad dk 7 vad ch ,l vkj dksM] pkyku tek djus dh rkjh[k
(fnu] ekg] o"kZ) rFkk pkyku Øe la[;k dh eksgj yxh gS A Ñi;k bl izfri.kZ dks vius
ikl j[ksa rFkk viuh vk; dh fooj.kh esa mDr ikorh ds C;ksjs dk mYys[k djsa A
CHECK BEFORE LEAVING THE BANK COUNTER THAT THE ACKNOWL-
EDGEMENT STAMPED ON YOUR COUNTER FOIL BY THE BANK BRANCH
BEARS THE NAME OF BANK BRANCH, THE 7 DIGIT BSR CODE OF THE
BRANCH, THE DATE OF DEPOSIT OF CHALLAN (DD MM YY) AND THE
CHALLAN SERIAL NO. PLEASE RETAIN THIS COUNTERFOIL AND MEN-
TION THE ABOVE ACKNOWLEDGEMENT DETAILS IN YOUR RETURN OF
INCOME.