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Single Copy (to be sent to the ZAO)

Tax Applicable (Tick one)


CHALLAN

(0020)Income Tax on Comapanies (Corporation Tax)

NO./ ITNS 280

(0021) INCOME TAX (OTHER THAN COMPANIES)

[a]

PAN :-

Assessment Year
2015-2016

*ABCPP1758M

ABCPP1758M

ABCPP1758M

Name :-

SURESHBHAI GANDALAL PATEL

Address :-

21, NALKUNJ SOCIETY, CAMP ROAD, SHAHIBAUG, AHMEDABAD, GUJARAT-380004

Type of Payment (Tick One)

[ ]
[a ]
[ ]

Advance Tax (100)


Self Assessment Tax (300)
Tax on Regular Assessment (400)

Surtax (102)
Tax on Distributed Profits of Domestic Companies (106)
Tax on Distributed Income to Unit Holders (107)

DETAIL OF PAYMENTS
Amount (In `. Only)
Income Tax

[
[
[

]
]
]

FOR USE IN RECEIVING BANK


Debit to A/c / Cheque credited on

76396

Surcharge

0
DD

Education Cess

MM

YY

2292

Interest

16272

Penalty

Others

Total

SPACE FOR BANK SEAL

94960

Total (in words):


CRORES

LACS

THOUSANDS
Ninty Four

Paid in Cash/Debit to A/c/Cheque


No.

HUNDERDS
Nine

TENS
Six

UNITS
Zero

Dated

Drawn on
(Name of the Bank and Branch)

Date:

Signature of the Person making payment

Taxpayers Counterfoil (To be filled up by tax payer)


SPACE FOR BANK SEAL
PAN

ABCPP1758M

Received from

SURESHBHAI GANDALAL PATEL

Cash/Debit to A/c/Cheque No.

`. (in Words)

For `.

94960

Ninty Four Thousand Nine Hundred Sixty Only.

Drawn on
(Name of the Bank and Branch)

On account of income Tax on


Type of Payment
For the Assessment Year

Income Tax (Other than Company)


Self Assessment
Tax
2015-2016

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