Income Declaration Scheme - Challan - 2016

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*Important : Please see notes
Single Copy (to be
INCOME DECLARATION SCHEME, 2016 CHALLAN
overleaf before filing up the
sent to the ZAO)
challan
CHALLAN
Assessment Year
OTHER TAXES ON INCOME AND EXPENDITURE (0028)
NO./ ITNS
PAYMENT UNDER INCOME DECLARATION SCHEME, 2016 (111)
2 0 1 7
-
1 8
286
Permanent Account Number
Full Name
Complete Address with City & State
Tel. No.
Pin
Type of Payment
FOR USE IN RECEIVING BANK
(Tick One)
Debit to A/c / Cheque credited on
Payment made by Company
D
D
M
M
Y
Y
Payment made by person other than Company
DETAILS OF PAYMENT
Amount (in Rs. Only)
Tax
SPACE FOR BANK SEAL
Surcharge (Krishi Kalyan Cess)
Penalty
Total
Total (in words)
CRORES
LACS
THOUSANDS
HUNDREDS
TENS
UNITS
Paid in Cash/Debit to A/c/Cheque No.
Dated
Drawn on
(Name of the Bank and Branch)
Date
Rs.
Signature of person making payment
Taxpayers Counterfoil (To be filled up by taxpayer)
SPACE FOR BANK SEAL
PAN
Received from
(Name of Taxpayer)
Cash/Debit to A/c/Cheque No.
For Rs.
Rs. (in words)
Drawn on
(Name of the Bank and Branch)
Payment made under Income Disclosure Scheme, 2016 (111) (Tick one)
Payment by Company
Payment by person other than Company
Rs.
Assessment Year
2
0
1
7
-
1
8

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