Challan for payament of Service Tax, Interest, Penalty etc.

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..... e of the Bank/Branch with Code No. . Division (Code No ) Range . (Code No ) Name of the Focal Point Bank (Code No .) Name and address of the assessee (Code No. . ) By whom tendered . Full Pa .....

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..... (in words) Rs Date Signature of the tenderer (To be filled by the Bank) Received payment (in word) Rupee .. Space for Focal Point Bank indicating the date, amount credited to Government Account. Signature of the Authorised Officer of the Bank Bank's Receipt Stamp: Name o .....

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