*Important : Please see notes overleaf Single Copy (to be sent to

before filling up the challan. T.D.S/TCS TAX CHALLAN the ZAO)

CHALLAN NO./ Tax Applicable (Tick One)* Assessment Year
ITNS TAX DEDUCTED/COLLECTED AT SOURCE FROM -
281 (0020) COMPANY √ (0021) NON-COMPANY
DEDUCTEES DEDUCTEES
Tax Deduction Account No. (T.A.N)

Full Name

Complete Address with City & State

Tel. No. Pin

Type of Payment Code * 9 2 B
(Tick One) (Please see overleaf)
TDS/TCS Payable by Taxpayer [200] √ FOR USE IN RECEIVING BANK

TDS/TCS Regular Assessment (Raised by I.T Deptt.) [400]

DETAILS OF PAYMENT Amount (in Rs. Only)

Income Tax Debit to A/c / Cheque credited on
Surcharge
Education Cess
Interest D D M M Y Y
Penalty
Total 0
Total (in words) SPACE FOR BANK SEAL
CRORES LACS THOUSANDS HUNDREDS TENS UNITS

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

Drawn On.
(Name of the Bank and Branch)
Date :
Signature of person making payment Rs.

Taxpayers Counterfoil (To be filled up by taxpayer) SPACE FOR BANK SEAL

TAN 0 0 0 0 0 0 0 0 0 0
Received from
(Name)
Cash/ Debit to A/c /Cheque No. 0 For Rs. 0
Rs. ( in words)
drawn on 0
(Name of the Bank and Branch)
Company √ Non-Company Code*
on account of Tax Deducted at Source (TDS) √ Tax Collected at Source (TCS)
(Strike out whichever is not applicable)
for the Assessment Year Rs.