,Ii >..~-

j' f 5 5ORIGINAL DUPLICATE

\ ,1\ ( To be retained by the payer) ( To be furnished by the payer to the respective Assessing Authority),

I! / FORM FOCHALLAN CHALLA

X I - Sales Tax (Central) XII - Sales Tax (Central)"r Receipt under the Central Sales Tax Act Receipt under the Central Sales Tax Act \

Challan of Tax, Penalty, Composiiion Money, Registration Fees and Other Fees paid Challan of Tax, Penalty, Composition Money, Registration Fees and Other Fees paid{ Treasurv/Sub- Treasurv _ { Treasury/Sub- Treasury

to the Branch of the State Bank of India to the' " Branch of the State Bank of India; Reserve Bank of India Reserve Bank of India

For the period fr to For the period from , to--I • I

", By horn tendered of Amount in By whom tendered Payment on account of AmoJnt inPayment on account

figures \ '"figures L

Name ind address of the person on whose (i) Ta'( Name and)ddress of the person ~n whose (i) Tax

behalf money is paid (ii) Penalty under Section Behalf money is paid I' (ii) Penalty under Section--

I(iii) Composition money (iii) Composition money/ II - -t. . i , C 'fi (iv) Registration Fee , (iv) Registration FeeegIs anon ern icate '0 Registration Certificat o.--

iIs ued by the Sales Tax ffice of(v) Other Fees l Issued by the Sales Tax ffice of

(v) Other Fees

~

Ii Ward. Tftal :- \ ,/ Ward. Total :-- --/

J

Rupe~~in wor s)__ 1 Rupe s (in words)/"

" I,r t : Dated:I- \, ' Signature of dealer or Depositor:

i , \ Signature of dealer or Depositor :, >'1 (For use in treasury) ) (For use in treasury)•

11:.\l. Rece~' pa ent ofRs .............................................. (in fi res) l. eceived payment ofRs .............................................. (in figures)Rup es. r r : •••••••• , •••••••••••••••••••••••••••••••••••••••••••••••••••• (in words) Rup es .......................... '" ...................................... (in words)

2. Date of entry ...................... Challan No ............................... 2. Date of entry ...................... Challan No ...............................

Treasurer Accountant Treasury Officer Treasurer Accountant Treasury OfficerAgent or Manager Agent or Manager

---------- _ ..•_------------- ------------------- -------------------------- ---------------------------- ------------------- --------------------------Stamp l fTreasury ) Stamp of Treasury ~

I

{GovtJPrinting Press. Daman 0212008'- 5,OOO} {Go I. Printing Press, Daman 0212008 5,()()0}

STRIpLICATE( For the Treasury )

SQUADRUPLICATE

( To be sent by the Treasury to the respective Sales Tax Office)

FORMCHALLAN

XII - Sales Tax (Central)Recei t under the Central Sales Tax Act

of 1", x, Penalty, Composition Money, Registration Fees and Other Fees paidTreasury/Sub- Treasury

Branch of the State Bank ofIndiaReserve Bank of India

erio from --------------------

-':-- ~. Ward.

By whom tendered '--- _Payment on account of Amount infigures

(i) Tax

(ii) Penalty under Section

(iii) Composition money

(iv) Registration Fee

(v) Other Fees

Si ature of dealer or De ositor:

(For use in treasury)I. Received payment of Rs. . (in figures)

Rupees (in words)2. Date of entry Challan No .

Treasurer Accountant Treasury OfficerAgent or Manager

Stamp of Treasury

Challan of Tax, Penalty, Composition Money, Registration Fees and Other Fees paid

{

Treasury/Sub-Treasuryto the Branchof the State Bank of India

Reserve Bank of IndiaFor the period from to _

Behalfmoney is paid _

Registration Certificate o. _

Issued by the Sales Tax Officer of __

11I Ward

R pees (in words),

Date : ._

Payment on account of Amounti~,l figures

J(i) Tax

(ii) Penalty under Section

(iii) Composition money

J(iv) Registration Fee

(v) Other Fees

, Total ;-

(For use in treasury)1. Received payment ofRs (in figures)

Rupees " (in words)2. Date of ent Challan No .

Treasurer Accountant

{Govt. Printing Press, Daman. 0212008 - 5,OOO}

Stamp of Treasury

{Govt Printinv Press, Daman. 02120()8 5,OOO}

Treasury OfficerAgent or Manager