Single copy (to be sent to the ZAO)

CHALLAN CHALLAN NO. NO. ITNS 280 281 ITNS

Tax Applicable (Tick One)* TAX DEDUCTED / COLLECTED AT SOURCE FROM (0020) COMPANY DEDUCTEES (0021) NON COMPANY DEDUCTEES

Assessment Year

Tax Deduction Account Number (TAN) Full Name Complete Address with city & state

C H AL LA N N O.
PIN

Tel. No

IT Code Type of Payment NS TDS / TCS Payable by Taxpayer (200) 28 TDS / TCS Regular Assessment (Raised by I.T. Dept)(400) 0
Amount (in Rs.)

DETAILS OF PAYMENTS

Income Tax Surcharge Education Cess Interest Penalty Total Total (in words)
CRORES LACS THOUSANDS HUNDREDS TENS UNITS

FOR USE IN RECEIVING BANK Debit to A/c / Cheque credited on

DD MM YY SPACE FOR BANK SEAL

Paid in

Cash/ Debit to A/c/Cheque No.

(Name of the Bank and Branch)

Dated

Drawn on

Date:

Signature of person making payment

Tear Off

Taxpayers counterfoil (To be filled up by tax payer) TAN

Received from (Name) Cash/ Debit to A/c/Cheque No. Rs. (in words) Drawn on
(Name of the Bank and Branch)

SPACE FOR BANK SEAL

For Rs.

Company

Non-Company

Deductees

On account of Tax Deducted at Source (TDS) / Tax Collected at source (TCS) from

For the Assessment Year