"FORM NO.

27E
(See section 206C and rule 37E)
Half yearly return of collection of tax under section 206C of I.T. Act, 1961 in respect of collections for the period ending ................
1. Particulars of Seller
(a) Name of Seller
(b) Address : Flat / Door/ Block No.
Name of Premises / Building/
Road / Street / Lane
Area / Locality /
Town / District / City PIN
State

(c) Tax Collection Account Number

(d) Permanent Account Number
2.* Has address of the seller changed Tick as applicable Yes No
3. (a) Please tick the boxes below indicating the collection made during the half year from which tax was required to be collected at source by you under the Income Tax Act, 1961
A human consumption Timber obtained under a forestBlease.
Alcoholic liquor for
Timber obtained by D
C any mode other than under a forest lease Any other forest produce not being timber or tendu leaves
E Scrap
(b) Please furnish information in separate Annexures as per the enclosed proforma for each type of collection indicated in item (a) above.
4. Details of tax collected and paid to the credit of the Central Government

S. N o . S ec t io n C o d e Am o un t C o ll e ct e d Tra n sf e r Vo u c he r / C ha l la n N o. g iv e n by Ba n k D a t e of Tra n sf e r V o uc h e r B a nk B ra n ch C o d e
( 1 35 ) ( 1 36 ) (1 3 7 ) ( 1 38 ) (1 3 9 ) (1 4 0 )
/ C h a ll a n

T ot al

N o t e - Wh e re co l le c t io n is m a d e b y o r o n b e h a lf o f t h e G o ve rn m e n t t o gi ve p a rt i cu la r s o f t ra n s f er v o u ch e rs; o t h e r de d u ct o r s t o g iv e p a rt i cu l a rs o f ch a ll a n
VERIFICATION
no. re g ar d in g d e p o si t in t o
I, _________________________________________________________,
b an k.
hereby certify that all the particulars furnished above are correct and complete.

Signature of person
Placeresponsible
: for collecting tax at source _____________________________________________________________________
Name and designation of person responsible for collecting tax at source __________________________________________________________

Date :
___________________
* If address has changed give changed address in column 1(b)
 Annexure- -
Annexure

Details
Details of of purchase
purchase price
price of of ......................................1
......................................1 debited
debited / received
/ received forfor
thethe period
period ending.........................
ending......................... and
and of of
taxtax collected
collected at at source2
source2

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anrm a n en
D at t e Ac of
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i bngemon
Na r e fora n dn on-
Ad d re s s o f b u ye r (A d d re sTo
s t nale e dva lu e of t h Am
e ou n t o f Da te o n wh i ch R at ae t A mo u n t o f t aDxat e o n w h ic h tDa at
x e o n w h ic h t a xB a nk B ra n ch C o d e
Bu y er
n u mb e r g i ve (nPA NTa) x o fC o bll uecyet io
r n c ollec nion
o t/ blow
e g i ve n i f P AN is m e n t io n ep du r ch a se ( s) p a ym e n t (R s . ) a mo u nt pa i d/ d e bi t w
edhic h c o ll e ct e d co l le ct e d p a id t o t h e c re di t of
C od e 3b yb a n k co lle c ti on if er
t
Ce r t if i ca t e t ax ( R s. )
) co ll e ct e d
Ce n t ra l Go ve rn m e nt 4
a ny5

( 1) (1 2 ) (1 3 ) (2 ) (14) ( 3) ( 4) (5 ) ( 6) ( 7) ( 8) (9 ) ( 1 0 ) (1 1 )

Notes : -

1 Please write.
A Alcoholic liquor for human consumption B Timber obtained under a forest lease.

C Timber obtained by any mode other than under a forest lease Any other D
forest produce not being timber or tendu leaves E Scrap
2 Please use separate Annexures for each type of collection.
3 Please enter Buyer Code 01 for companies, 02 for 'other than companies'.
4 Where collection is made by or on behalf of the Government, transfer voucher number may be entered in column (9).
5 If necessary, please use additional sheets to give full details of collection in the above format. Please also give running serial number to all pages.
6 Write X if lower collection is as per section 206C(9).
Write Y for any other reason, give details in separate sheet.
Signature
Signatureofofperson
personresponsible
responsiblefor
forcollecting
collectingtax
taxatatsource____________________________________________________________________________
source____________________________________________________________________________

Name and designation of person responsible for collecting tax at source_________________________________________________________________" ;