Form for furnishing information with the statement of deduction / collection of tax at source ( tick whichever is applicable ) filed on computer media for the period Q4 (From 01/01/19 to 31/03/19 (dd/mm/yy)#) 1 (a) Tax Deduction Account No. JBPA01278E (d) Financial Year 2018-19 (b) Permanent Account No. ADYPM8609G (e) Assessment year 2019-20 (c) Form No. 26Q (f) Previous receipt number NA (In case return/statement has been filed earlier) 2 Particulars of the deductor / collector 3 Name of the person responsible for deduction / collection of tax (a) Name AMIT MAHESHWARI (a)Name AMIT MAHESHWARI (b) Type of deductor* INDIVIDUAL/HUF (b)PAN ADYPM8609G (c) Branch / division (if any) CHHINDWARA (c)Address (d) Address Flat No. PADMAWATI SALES Flat No. PADMAWATI SALES Name of the premises/building GANDHI GUNJ Name of the premises/building GANDHI GUNJ Road / street / lane CHHINDWARA Road / street / lane CHHINDWARA Area / location CHHINDWARA Area / location CHHINDWARA Town / City / District CHHINDWARA Town / City / District CHHINDWARA State MADHYA PRADESH State MADHYA PRADESH Pin code 480002 Pin code 480002 Telephone No. 07162-235270 Telephone No. 07162-235270 E-mail PADMAWATISALES10@GMAIL.COM E-mail PADMAWATISALES10@GMAIL.COM 4 Control totals Tax deposited Return Type No. of deductee / party Amount paid Tax deducted / collected Sr. No. (Total challan amount) (Regular / Correction type) records ( ) ( ) ( ) 1 REGULAR 8 1651300.00 165130.00 165130.00 Total 8 1651300.00 165130.00 165130.00 5 Total Number of Annexures enclosed 6 Other Information VERIFICATION I, AMIT MAHESHWARI , hereby certify that all the particulars furnished above are correct and complete. Place: CHHINDWARA Signature of person responsible for deducting / collecting tax at source Date: 19/05/2019 Name and designation of person responsible for deducting / collecting tax at source AMIT MAHESHWARI, PROPRIETOR * Mention type of deductor - Government or Others # dd/mm/yy :- date/month/year