FORM VAT - 2

(See rule 3, 28, 32, 37 And 46)

CHALLAN

Invoice of Tax paid into Treasury/Sub Treasury/Branch of

State Bank of India/State Bank of Patiala or any other Bank authorized to transact
Government business and credited to the Head of Account "0040-Taxes on
Sales, Trade etc-102 State VAT".

District Faridkot(FKT-00-509)
Period From 01/04/16 To 30/06/16
Last Date of Payment 01/08/16
1. By Whom tendered AMIT PURI
2. Name of the Person M/S GANPATI MEDICAL AGENCY
Complete Address QUILA ROAD KOTKAPURA
VRN/TRN 03322190719
(a) Voluntary Tax VAT/TOT / Advance
Rs.1793
Tax
(b) Additonal Demand : Rs.0
(c) Penalty U/S : Rs.0
(d) Interest : Rs.18
(e) other Deposits : Rs.0

(f) Total in Figures : Rs.1811

(g) 89% of the amount at 2 (f) Rs.1612
(h) : Addional Tax Payable under
Rs.0
section 8 - B
(i) 80% of the amount at 2 (h) above Rs.0
(j) Total amount deposited 2(g) + 2(i)
Rs.1612
(IN FIGURES)
(k) TOTAL AMOUNT DEPOSITED IN
WORDS "0040 Taxes on sales, Trade Rs. One Thousand And Six Hundred And Twelve Rupees Only
etc - 102 State VAT "
(l) PMF : 11% of 2(f)
Rs.199
credited in account of PMF
(m) PIMF : 20% of 2(h)
Rs.0
credited in account of PMIDF
TOTAL TAX IN FIGURES

Total of (Treasury) VAT 11% Additional Tax 20%

Grand Total
2(g) + 2(i) 2(l) PMF PIMF 2 (m)

1612 199 0 1811.00

TOTAL TAX IN WORDS Rs. One Thousand And Eight Hundred And Eleven Rupees Only
Bank Receipt No : IKB9876838
Date and Time of transaction:01/08/2016&05:55:49 PM
Certified that all the particulars given above are correct.

Signature of the depositor

(Designated Officer)
Seal of Designated Officer