CHALLAN FOR DEPOSITE OF GOODS AND SERVICES TAX

CPIN: Date: Challan Expiry Date :

QSD
GSTIN : Email Address :
Name : Address :
(legal)

Mobile No.:

Details of Deposite (All amount in Rs.)

Minor Head
Government Major Head
Tax Interest Penalty Fee Others Total

Central
Tax 100 200 200 a 100 600
(______)

Integrated
Government of Tax 100 200 200 100 600
India (______)

Cess 100 200 200 200 700

(______)

Sub-Total 100 2000 200 300 2600

State (Name) State Tax 100 200 100 400

(______________) (______)

UT (Name) UT Tax 100 200 200 100 600

(______________) (______)

Total Challan Amount : 600 3000 1000 200 700 5500

Total Amount in Words : Five thousand six hundred rupees only,
 Mode of Payment (relevent part will become active when the particular mode is selected)

E-Payment Over the Counter (OTC)

(This will include all modes of Bank (Where cash or instrument is

E-Payment such as CC/Dc and proposed to be deposited)
net banking. Taxpayer will
choose one of this) Details of Instrument
Cash Cheque Demand Draft

NEFT/RTGS
Remitting Bank
Beneficiary Name
Beneficiary Account Number (CPIN)
Name of Beneficiary Bank
Beneficiary Bank's Indian Financial System Code (IFSC)
Amount
Note : Charges to be separately paid by the person making payment.

Particulars of Depositor
Name
Designation / Status (Manager, Partner etc.)
Signature
Date

Paid Challan Information

GSTIN
Taxpayer Name
Name of Bank
Amount
Bank Reference No. (BRN)/UTR
CIN
Payment Date
Bank Account Number (For Cheque/DD
deposited at Bank's counter)
Note - UTR stands for Unique Transaction Number for NEFT / RTGS payment

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