Single(Copy to be sent the ZAO)

Tax Applicable(Tick One)*

CHALLAN NO./

Assessment Year

(0020) INCOME-TAX ON COMPANIES

ITNS

(CORPORATION TAX)

280

(0021) INCOME TAX

2015-16

(OTHER THAN COMPANIES)

Permanent Account Number

ABBPH3290F

ABBPH3290F
Full Name
Valerie Jane Hara
Complete Address With City and State

W/O Surinder Singh Hara,Hara Farm House,P.O. Office Amadal Pur,Jagadhri,Jagadhri,HARYANA,135101

Tel. No.

Pin135101
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

3545000

Income Tax
Surcharge

Education Cess

Interest

Penalty

Others

debit to A/c /Cheque Credit on

DD

MM

YY

SPACE FOR BANK SEAL

3545000

Total

Total(in words)
CRORES

LACS
THIRTY
FIVE

THOUSANDS HUNDREDS

TENS

UNITS

FORTY FIVE

Paid in Cash/Debit to Ac/Cheque No

Cash

Dated

Drawn on
(Name of Bank and Branch)
Date

14/03/2015

Signature of person making Payment Rs.

Taxpayers Counterfoil(To be Filed up by the tax payer )

PAN

ABBPH3290F

Received Form

Valerie Jane Hara

Cash/Debit to Ac/Cheque No

Rs in Words

Cash

For Rs.

SPACE FOR BANK SEAL

3545000

THIRTY FIVE LAKH FORTY FIVE THOUSAND Only

Drawn on
(Name of the Bank and Branch)

On Account of Other than Companies

Income Tax on
Advance Tax
Type of Payments
for the Assessment Year

2015-16

Code

V339Rs.