Form 26Q. (See section 193, 194, 194A, 194B, 194BB, 194C, 194D, 194EE, 194F, 194G, 194H, 194I, 194J, 194LA and rule 31A)

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Form 26Q (See section 193, 194, 194A, 194B, 194BB, 194C, 194D, 194EE, 194F, 194G, 194H, 194I, 194J, 194LA and rule 31A) Quarterly Statement of Deduction of tax under sub-section (3) of section 200 of income tax act in respect of payments or than salary for quarter ended (june/ September/ December/ March).. (Financial Year) 1. (a) Tax and and collection Account Number (TAN) (b) Has statement been filled earlier for this quarter (yes/no) (c) Permanent Account No. (PAN) (see note 1) (d) If answer to (d) is yes m Token No. of Original statement (e) Financial Year (f) Type of Deductor (see note 2) 2. Particular of deductor (employer) (a) Name of employer (b) If central /state government Name (see note 3) AIN code of PAO/TO/CDDO TAN registration No. (c) Address Flat No. Name of 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) 3. Particulars of person responsible for of Tax: (a) Name (b) Address Flat No. Name of 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 deducted and paid to credit of Central Government: Sr No 40 1 Tax Interest Fee (see note no 5) 40 2 Penalty/ Ors Total amount deposited as per challan book adhustment (402+403+404+405+406 ) See note 6 Mode of deposit through challan / book adjustment (b) (see note 7) BSR Code Receipt No. of form 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 (see note 8) 403 404 405 406 407 408 409 410 411 Minor head of challan (see note 9) 5. Details of amount paid and tax deducted reon from employees (see annexure) (i) Enclose annexure I along with each statement having details of relevant quarter (ii) Enclose annexure II along with last statement i.e for quarter ending 31 st March having details for whole financial year Verification I,.. hereby certify that all particulars furnished above are correct and complete. Place: Signature of person responsible for deducting tax at source Date: Name and Designation of person responsible for deducting tax at source

Notes: 1. It is mandatory for Non-government deductors to Quote PAN. In case of Govt. deductor PANNOTREQD should be mentioned. 2. Please indicate Govt. deductor or Non- Govt deductor. 3. In case of Central Govt, please mention name of Ministry/Department. In case of State Government, please mention name of state. 4. In alternate Telephone Number and alternate e-mail, please furnish telephone No. and e-mail of a person who can be contacted in absence of Deductor or person responsible for of tax. 5. Fee paid under section 234E for late filing of TDS statement to be mentioned in separate column of FEE (column 404) 6. In column 406, Govt DDOs to mention amount remitted by PAO/CDDO/DTO. Or deductors to write exact amount deposited through challan. 7. In column 408, govt. deductors to write B where TDS is remitted to credit of central govt. through book adjustment. Or Deductors to write C. 8. Challan/ Transfer Voucher (CIN/BIN) particulars i.e 408, 409, 410 should be exactly same as available at tax information network. 9. In column 411, mention minor head as marked on challan. Annexure : Deductee wise Break up of TDS (Please use separate Annexure for each line item in Table at Sl No. 04 of main Form 26Q) Details of amount paid/credited during quarter ended. (dd/mm/yyyy) and of tax deducted at source BSR Code of Branch/ Receipt No. of Form 24G Date on which challan deposited/transfer Voucher Date Name of Employer TAN Challan Serial No. / DDo Serial No. of Form No. 24G Amount as per challan Total TDS to be allocated among deductees as in vertical total of col 421 Total interest to be allocated among deductees mention below Sr No Deductee ref no. provided by Deductee code (01- company 02- or PAN of deductee Name of deductee Section Code (See Note 7) Date of Payment or Credit Amount paid or credited Tot al tax de Total tax deposited Date of Rate at which deduct ed Reason for non /lower No. of certificate u/s 197 issued by

deductor, if avalable than company) 412 413 414 415 416 417 418 419 42 0 duc ted / higher / threshold/ transporte r (see note 1to 6) 421 422 423 424 425 assessing officer for non/ lower Verification I, hereby certify that all particulars furnished above are correct and complete. Place: Signature of person responsible for deducting tax at source Date: Name and Designation of person responsible for deducting tax at source Notes: 1. Write A if lower or no is on account of a certificate u/s 197 2. Write B if no is on account of a certificate u/s 197A 3. Write C if is on higher rate on account of non- furnishing of PAN by deductee. 4. Write Y if no is on account of payment below threshold limit specified in income tax act, 1961. 5. Write T if no is on account of deductee being transporter. Pan of deductee is mandatory. [Section 194C(8)]. 6. Write Z if no is on account of payment being notified u/s 197A(1F). 7. List of section code is as under : Section Nature of Payment Section Code 193 Interest on securities 193 194 Dividend 194 194A Interest or than interest on securities 94A 194B Winning from Lotteries crossword Puzzles 94B 194BB Winning from horse race 4BB

194C Payment of contractors and sub- contractors 94C 194D Insurance commission 94D 194EE Payment in respect of deposits under NSS 4EE 194F Payment on account of re-purchase of units by mutual Funds or 94F UTI 194G Commission, prize etc on sale of lottery tickets 94G 194H Commission or brokerage 94H 194I(a) Rent 4IA 194I(b) Rent 4IB 194J Fees for professional or technical services 94J 194LA Payment of compensation on acquisition of certain immovable property 4LA