Single Copy (to be sent to the ZAO)

Tax Applicable (Tick One) CHALLAN NO./ITNS 280 (0020) INCOME-TAX ON COMPANIES (CORPORATION TAX) (0021) INCOME TAX (OTHER THAN COMPANIES) Assessment Year

Permanent Account Number Full Name Complete Address with City & State Phone No. PIN Type of Payment (Tick One) Advance Tax (100) Self Assessment Tax (300) Tax on Regular Assessment (400) DETAILS OF PAYMENTS Income Tax on pension Surcharge Education Cess Interest Penalty Others Total Total (in words) Crores

Surtax (102) Tax on Distributed Profits of Domestic Companies (106) Tax on Distributed Income to Unit Holders (107) FOR USE IN RECEIVING BANK Debit to A/c / Cheque credited on DD/MM DD MM 0

~ ~ ~ ~ ~ ~ ~
0

Dated SPACE FOR BANK SEAL

Rupees Nil
Lacs Thousands Hundreds Tens Units

CHEQUE DRAWN No. Paid in Drawn on (Name of the Bank and State Bank of Travancore, Main Branch, Statue, Branch) Thiruvananthapuram

Date :

Signature of person making payment Taxpayers' Counterfoil (To be filled up by tax payer)

PAN NUMBER Received from (Name) CHEQUE DRAWN No. Rs. (in words) Crores 0

0
0

0
For $

SPACE FOR BANK SEAL

0 Rupees Nil
Lacs 0 Thousands 0 Hundreds 0

Tens 0

Units 0

Drawn on (Name of the Bank and Branch) on account of Type of Payment Assessment Year

State Bank of Travancore, Main Branch, Statue, Thiruvananthapuram Income tax other than companies /Advance Tax (100)

CHEQUE DRAWN No. 0

0 $ 0