FORM 10 QkeZ

[See rule 15(2) ]

CHALLAN

10

pkyku

The Madhya Pradesh Vritti Kar Adhiniyam , 1995

e/;iznsk o`fRrdj vf/kfu;e ] 1995

Value Rs.__________________________j (in words)

(028 Othre taxes on Income and expenditure B Taxes on)

Profession , Trades, Calling and Employment)
By
Name, Address ,
Payment on account of
Amount
Whom
registration No. & case
rendered
No. if any on whose
behalf the money is paid
1
2
3
4
Rs..
(a) Tax according to
return for the period
from......................to
...............................
(b) tax demand after
assessment for the
period
from .....................
to .............................
(d) Penalty ...............
(d) composition fees

Total Rs. ............................................(in figure)

Rs...........................................
......................................................(in words)
.......................................
Date ...............................
Signature
of Depositer
(FOR USE IN THE TREASURY OR THE BANK)
1. Received Payment of Rs............................................................(In
figures)
Rs......................................................................................................
(in words)
Date of
entry....................................................................................................
.............................................................................................................
............
Treasurer

Accountant

Treasury Officer/
Agent or Manager

P.