INCOME TAX DEPARTMENT

Challan Form For Making Tax

Payment Through Pay At Bank Counter Mode

CRN Challan Generated on Valid till

Name :
e-mail ID :
Mobile No. :
PAN A.Y. F.Y. Major Head Minor Head ZAO Code

Tax Breakup Details (Amount In ₹)

A Tax - For Use In Receiving Bank

B Surcharge - Debit to A/c / Cheque credited on

C Cess -

D Interest - DD MMM YYYY

E Penalty - Space for bank seal

F Others -

Total (A+B+C+D+E+F) -

Total (In Words) Zero Rupees

Mode of Payment :

Payment through :

Drawn on 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

Name Amount Major Head

- DD MMM YYYY
Minor Head Payment through ZAO Code Space for bank seal
Drawn on Bank

Branch Name : CIN : Date :

Bank Reference Number Cheque No./DD No. :
(BRN) :