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Quarterly statement of Tax Collection at Source under section 206C of Income-tax Act, 1961 for the quarter ended June / September / December / March (Tick whichever is applicable) ..... (year)

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..... (d) Has the statement been filed earlier for this quarter (Yes/No) (e) If answer to (d) is Yes , then Token No. of original statement (f) Type of Collector (See Note 2) 2. Particulars of the Collector (a) Name of the Collector (b) If Central/State Government Name (See Note 3) AIN Code of PAO/TO/CDDO (c) TAN Registration No. (d) Address Flat No. Name of the premises/building Road/Street/Lane Area/Location Town/City/District State PIN Code .....

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..... 2 3 5. Details of amount paid and ta .....

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..... Amount as per Challan Total TCS to be allocated among collectees as in the vertical total of Col. 677 Total interest to be allocated among the collectees mentioned below Sl. No. Collec tee refere nce numbe r provid ed by the collect or, if availa ble Collec tee code (see Note 10) Whet her reside nt or nonreside nt (Y/N) PAN of the Collectee Whether collectee opting out of taxation regime u/s 115BAC(1A)? Name of Collec tee Total value of the transact ion Amount received / debited Date on which amou nt receiv ed/ debite d (dd/ mm/ yyyy) Collect ion Code (See Note 11) Tax Surcharge Healt h and Educ ation C .....

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..... Date of payment of TDS to Central Government [677] [678] [679] [680] [681] [681A] [681B [681C] Verification I, , hereby certify that all the particulars furnished above are correct and complete. Signature of the person responsible for collecting tax at source .. Name and designation of the person responsible for collecting tax at source .. .....

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..... ction code as mentioned below: Section Nature of collection Collection Code 206C Collection at source from alcoholic liquor for human consumption 6C A 206C Collection at source from timber obtained under forest lease 6C B 206C Collection at source from timber obtained by any mode other than a forest lease 6C C 206C Collection at source from any other forest produce (not being tendu leaves) 6C D 206C Collection at source from scrap 6C E 206C Collection at source from contractors or licensee or lease relating to parking lots 6C F 206C Collection at source from contractors or licensee or lease r .....

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..... ******* NOTES:- 1. For further amendment vide NOTIFICATION NO. 54/2020 dated 24-07-2020 w.e.f. 01-10-2020 2. Substituted vide NOTIFICATION NO. 71/2021 dated 08-06-2021 before it was read as [See section 206C and rule 31AA] 3. Substituted vide NOTIFICATION NO. 71/2021 dated 08-06-2021 4. Substituted vide NOTIFICATION NO. 28/2023 dated 22-05-2023 w.e.f. 01-07-2023 before it was read as, Education Cess 5. Substituted vide NOTIFICATION NO. 28/2023 dated 22-05-2023 w.e.f. 01-07-2023 before it was read as, 3 [ ANNEXURE -: PARTY WISE BREAK UP OF TCS (Please use separate Annexure for each-line item in Table at Sl. No. 04 of main Form 27EQ) Details of amount received/debited during the quarter ended ................................................................................ (dd/mm/yyyy) and of tax collected at source BSR Code of branch/Receipt Number of Form No. 24G Date on which challan deposited/ Transfer voucher date (dd/mm/yyyy) Challan Serial Number/DDO Serial No. of Form No. 24G .....

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..... -section (1H) and whether TDS has been deducted from such payment (if either F or G is selected in 680) If, answer to [681A] is yes, then Challan number Date of Payment of TDS to Central Government [674] [675] [676] [677] [678] [679] [680] [681] [681A] [681B] [681C] .....

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..... E 206C Collection at source from contractors or licensee or lease relating to parking lots 6C F 206C Collection at source from contractors or licensee or lease relating to toll plaza 6C G 206C Collection at source from contractors or licensee or lease relating to mine or quarry 6C H 206C Collection at source from tendu leaves 6C I 206C Collection at source on sale of minerals, being coal or lignite or iron ore 6C J 206C Collection at source on cash sale of bullion and jewellery 6C K 206C Collection at source on sale of motor vehicle 6C L 206C Collection at source on remittance under LRS for purchase of overseas tour program package 6C .....

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