Form for furnishing information with the return or statement of deduction of tax at source filed on computer media

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..... (c) Form No. (d) Financial Year (e) Assessment year (f) Previous recei .....

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..... Flat No. Name of the premises/building .....

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..... Pin code Telephone No. .....

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..... Road/street/lane Area/location .....

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..... rol totals Sr. No. No. of deductee/ party records Amount paid Rs. Tax deducted/collection Rs. Tax deposited (Total challan amount) Rs. Total 5. Total Number of Annexures enclosed 6. Other Information Verification I, , hereby certify that all the particulars furnished above are correct and complete. Place: .. Date: .. Signature of person responsible for deducting/collecting tax at sourc .....

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