INCOME TAX DEPARTMENT

Challan Form For Making Tax

Payment Through Pay At Bank Counter Mode

CRN Challan Generated on Valid till

24070900119732 09-Jul-2024 24-Jul-2024
ITNS No. : 284
Name : H******A M****L
e-mail ID : in***************@gmail.com
Mobile No. : 85XXXXXX07
PAN A.Y. F.Y. Major Head Minor Head ZAO Code
CBWPM7913D 2020-21 2019-20 Income Tax (Other than Payment of Demand/ 722005
Companies) (0021) Penalty/Interest etc. under
Undisclosed Foreign
Income And Assets And
Imposition of Tax Act,
2015 (Black Money Act)
(108)

Tax Breakup Details (Amount In ₹)

A Tax ₹ 29,800 For Use In Receiving Bank

B Surcharge ₹ 2,029 Debit to A/c / Cheque credited on

C Cess ₹ 658

D Interest ₹ 1,430 DD MMM YYYY

E Penalty ₹ 680 Space for bank seal

F Others ₹0

Total (A+B+C+D+E+F) ₹ 34,597

Total (In Words) Rupees Thirty Four

Thousand Five Hundred
And Ninety Seven Only

Mode of Payment : Pay at Bank Counter

Payment through : Demand Draft

Drawn on Bank : State Bank Of India

Branch Name : Cheque No./DD No. :

Name of the person making Date :
Signature of person making payment
payment :
Taxpayer’s Counterfoil
CRN A.Y. PAN
24070900119732 2020-21 CBWPM7913D
Name Amount Major Head
H******A M****L ₹ 34,597 Income Tax (Other DD MMM YYYY
than Companies)
(0021)
Minor Head Payment through ZAO Code Space for bank seal
Payment of Demand/ Demand Draft 722005
Penalty/Interest etc. under
Undisclosed Foreign Income
And Assets And Imposition
of Tax Act, 2015 (Black
Money Act) (108)
Drawn on Bank
State Bank Of India
Branch Name : CIN : Date :
Bank Reference Number Cheque No./DD No. :
(BRN) :