INCOME TAX DEPARTMENT

Challan Form For Making Tax

Payment Through Pay At Bank Counter Mode

CRN Challan Generated on Valid till

22122900100663 29-Dec-2022 13-Jan-2023
ITNS No. : 280
Name : G****v S*****a
e-mail ID : ga*********@gmail.com
Mobile No. : 83XXXXXX36
PAN A.Y. F.Y. Major Head Minor Head ZAO Code
BVVPS8719R 2022-23 2021-22 Income Tax (Other than Self-Assessment Tax (300) 722019
Companies) (0021)

Tax Breakup Details (Amount In ₹)

A Tax ₹0 For Use In Receiving Bank

B Surcharge ₹0 Debit to A/c / Cheque credited on

C Cess ₹0

D Interest ₹0 DD MMM YYYY

E Penalty ₹0 Space for bank seal

F Others ₹ 1,000

Total (A+B+C+D+E+F) ₹ 1,000

Total (In Words) Rupees One Thousand

Only

Mode of Payment : Pay at Bank Counter

Payment through : Cash

Drawn on Bank : ICICI Bank

Branch Name : Cheque No./DD No. :

Name of the person making Date :
Signature of person making payment
payment :
Taxpayer’s Counterfoil
CRN A.Y. PAN
22122900100663 2022-23 BVVPS8719R
Name Amount Major Head
G****v S*****a ₹ 1,000 Income Tax (Other DD MMM YYYY
than Companies)
(0021)
Minor Head Payment through ZAO Code Space for bank seal
Self-Assessment Tax (300) Cash 722019
Drawn on Bank
ICICI Bank
Branch Name : CIN : Date :
Bank Reference Number Cheque No./DD No. :
(BRN) :