INCOME TAX DEPARTMENT

Challan Form For Making Tax

Payment Through Pay At Bank Counter Mode

CRN Challan Generated on Valid till

24033100084356 31-Mar-2024 15-Apr-2024
ITNS No. : 280
Name : P*****A C*****Y
e-mail ID : av*******@gmail.com
Mobile No. : 97XXXXXX39
PAN A.Y. F.Y. Major Head Minor Head ZAO Code
CIMPC9774P 2023-24 2022-23 Income Tax (Other than Tax on Distributed Income 722005
Companies) (0021) to Unit Holders (107)

Tax Breakup Details (Amount In ₹)

A Tax ₹ 2,825 For Use In Receiving Bank

B Surcharge ₹ 130 Debit to A/c / Cheque credited on

C Cess ₹ 295

D Interest ₹ 325 DD MMM YYYY

E Penalty ₹0 Space for bank seal

F Others ₹0

Total (A+B+C+D+E+F) ₹ 3,575

Total (In Words) Rupees Three Thousand

Five Hundred And Seventy
Five Only

Mode of Payment : Pay at Bank Counter

Payment through : Cash

Drawn on Bank : State Bank Of India

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
24033100084356 2023-24 CIMPC9774P
Name Amount Major Head
P*****A C*****Y ₹ 3,575 Income Tax (Other DD MMM YYYY
than Companies)
(0021)
Minor Head Payment through ZAO Code Space for bank seal
Tax on Distributed Income Cash 722005
to Unit Holders (107)
Drawn on Bank
State Bank Of India
Branch Name : CIN : Date :
Bank Reference Number Cheque No./DD No. :
(BRN) :