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..... seller (a) Name (b) Address Flat/Door/Block No. Name of premises/Building Road/Street/Lane Area/Locality Town/City/District State Pin Code (c) Has address of the seller since submitting the last return Tick as applicable Yes No 3. Details of gross amount debited/received under section 206C(1) and tax collected thereon: Buyer Gross amount debited/received during the half-yearly peri .....

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..... y Address of the company Total value of the purchase(s) Amount debited/ received (Rs.) Amount of tax collected Date on which tax collected Date on which tax collected at source was paid to the credit of the Central Government Tax Collection Certificate Number Date of furnishing of tax collection Certificate to the company (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) Total (b) .....

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