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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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..... telephone No. (See Note 4) Email Alternate email (See Note 4) 3. Particulars of the person responsible for collection of tax: (a) Name (b) Address Flat No. Name of the premises/building Road/Street/Lane Area/Location Town/City/District State PIN Code Telephone No. Alternate telephone No. (See Note 4) Email Alternate email (See Note 4) Mobile No. 4. Details of tax collected at source and paid to the credit of the Central Government: Sl. No. Tax Surcharge 4[Health and Education Cess] Interest Fee (See Note 5) Penalty/ Others Total amount deposited as per challan/ Book Adjustment (652 +653 +654 +655 +656 +657) (See Note 6) Mode of deposit through Challan (C)/ Book Adjustment (B) (See Note 7) BSR code/ Receipt Number of Form No. 24G (See Note 8) Challan Serial No./DDO Serial No. of Form No.24G (See Note 8) Date on which amount deposited through challan/ Date of transfer voucher (dd/mm/yyyy) (See Note 8) Minor Head of Challan (See Note 9) [651] [652] [653] [654] [655] [656] [657] [658] [659] [660] [661] [662] [663] 1 2 3 5. Details of amount paid and tax collected thereon (see Annexure) Verification I, …………&he .....

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..... No. 24G Date on which challan deposited/Transfer voucher date (dd/mm/yyyy) Challan Serial Number/DDO Serial No. of Form No. 24G 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 Cess Total tax collected [673+674+675] [66 4] [665] [666A] [666B] [667A] [667B] [668] [669] [670] [671] [672] [673] [674] [675] [676] 1 2 3 Total Total tax deposited Date of collection (dd/ mm/ yyyy) Rate at which collected Reason for non- collection/ lower collection/ or collection at higher rate (See Note 1 to 9 .....

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..... 206CCA. 10. List of Collectee Codes Sl No. Party Code Description 1 01 Company 2 02 Individual 3 03 Hindu Undivided Family 4 04 Association of Persons (AOP) except in case of AOP consisting of only companies as its members 5 05 Association of Persons (AOP) consisting of only companies as its members 6 06 Co-operative Society 7 07 Firm 8 08 Body of individuals 9 09 Artificial juridical person referred to in sub-clause (vii) of clause (31) of section 2 of the Income-tax Act 1961 10 10 Others 11. Write collection 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 sour .....

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..... ............................................................. (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 Amount as per Challan Total TCS to be allocated among deductees as in the vertical total of Col. 677 Total interest to be allocated among the parties mentioned below Name of the Collector TAN Sl. No. Party reference number provided by the collector if available Party code (01- company 02- Other than company) PAN of the party Name of party Total value of the transaction Amount received /debited Date on which amount received/ debited (dd/ mm/ yyyy) Collection Code (See Note 10) Tax [664] [665] [666] [667] [668] [669] [670] [671] [672] [673] 1 2 3 Total Surcharge Education Cess Total tax collected [673+ 674+ 675] Total tax deposited Date of collection (dd/mm/yyyy) Rate at which collected Reason for non-collection/ lower collection/ or collection at higher rate (See Note 1 to 9) Number of the certificate u/s 206C issued by the Assessing Officer for lower collection of tax W .....

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..... 6C 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 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 O 206C Collection at source on remittance under LRS for educational loan taken from financial institution mentioned in section 80E 6C P 206C Collection at source on remittance under LRS for purpose other than for purcha .....

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