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e-Payment Request Form

PAN No./ TAN:


Full Name: _____________________________________
Assessment Year:
Address: ______________________________________
Financial Year:
__________________________________

Challan Major Head Type of Payment


ITNS 280 (0020) INCOME-TAX ON COMPANIES (100) ADVANCE TAX
(CORPORATION TAX)
(102) SURTAX
(0021) INCOME-TAX (OTHER THAN
COMPANIES) (106) TAX ON DISTRIBUTED PROFITS

(107) TAX ON DISTRIBUTED INCOME

(300) SELF ASSESSMENT TAX

(400) TAX ON REGULAR ASSESSMENT

ITNS 281 (0020) COMPANY DEDUCTEES (200) TDS/TCS Payable by Taxpayer

(0021) NON-COMPANY DEDUCTEES (400) TDS/TCS Regular Assessment (Raised by I.T.


Deptt.)

ITNS 282 (0034) SECURITIES TRANSACTION TAX (100) ADVANCE TAX

(0023) HOTEL RECIEPTS TAX (300) SELF ASSESSMENT TAX

(0024) INTEREST TAX (400) TAX ON REGULAR ASSESSMENT

(0028) EXPNDITURE/OTHER TAX

(0031) ESTATE DUTY

(0032) WEALTH TAX

(0033) GIFT TAX

ITNS 283 (0036) BANKING CASH TRANSACTION TAX (100) ADVANCE TAX

(0026) FRINGE BENEFITS TAX (300) SELF ASSESSMENT TAX

(400) TAX ON REGULAR ASSESSMENT

PAYMENT DETAILS PAYMENT INSTRUCTIONS


Please find enclosed Cheque Number _____________ on our Current Account
1. Tax Amount: ________________
No.______________________ Amounting to Rs._______________________
2. Surcharge: ________________
(Rupees________________________________________________________)
3. Education Cess: ________________
towards CBDT e-Payment.
4. Interest: ________________
5. Penalty: ________________ We confirm that any discrepancy in the Challan, if any, will be brought to the
notice of the Bank within one working day for any rectification.
6. Others: ________________

Total: ________________ Authorised Signatory

For Branch Use Only

Challan Identification Number (CIN): ______________________________________________

Name of the Designated Officer: __________________________ Signature:_______________

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