Single(Copy to be sent the ZAO)

Tax Applicable(Tick One)*

CHALLAN NO./ (0020) INCOME-TAX ON COMPANIES Assessment Year
ITNS (CORPORATION TAX)
280 (0021) INCOME TAX  2019-20
(OTHER THAN COMPANIES)
Permanent Account Number
ACEPN2521P ACEPN2521P
Full Name
MR SRI NIWAS
Complete Address With City and State
SHIV RICE MILL,NEAR TEEN MANDIR,RAMRAJ ROAD,BAJPUR,UDHAM SINGH NAGAR,UTTARAKHAND
Tel. No. 9412089124 Pin 262401

Type of Payment(Tick One)

Advance Tax(100) Surtax(102)
Self Assessment Tax (300)  Tax on Distributed Profits of Domestic Companies(106)
Tax on Regular Assessment(400) Tax on Distributed Income to Unit Holders(107)
DETAILS OF PAYMENTS Amount(in Rs.only) FOR USE IN RECEIVING BANK
Income Tax 47078 debit to A/c /Cheque Credit on
Surcharge 0
Health & Education Cess 0 DD MM YY
Interest 5192 SPACE FOR BANK SEAL
Penalty 0
Others 0
Total 52270
Total(in words)
CRORES LACS THOUSANDS HUNDREDS TENS UNITS
FIFTY TWO TWO SEVEN ZERO

Paid in Cash/Debit to Ac/Cheque No Dated

Drawn on
(Name of Bank and Branch)

Date 23/09/2019 Signature of person making Payment Rs.

Taxpayers Counterfoil(To be Filed up by the tax payer ) SPACE FOR BANK SEAL
PAN ACEPN2521P
Received From SRI NIWAS
Cash/Debit to Ac/Cheque No For Rs. 52270
Rs in Words FIFTY TWO THOUSAND TWO HUNDRED SEVENTY Only
Drawn on
(Name of the Bank and Branch)
On Account of Other than Companies
Income Tax on
Type of Payments Self Assessment Tax
for the Assessment Year 2019-20 Code S-0045 Rs.