G.A.R.

-7 Proforma for Service Tax Payments For payments from April 2007 onwards (Receipt & Payment Rules 26) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) Full Name Complete Address (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address)

(Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (Address) (TelephoneNumber) (TelephoneNumber) (TelephoneNumber) (TelephoneNumber) (TelephoneNumber) (TelephoneNumber) (TelephoneNumber) (TelephoneNumber) (TelephoneNumber) (TelephoneNumber) (Pincode) (Pincode) (Pincode) (Pincode) (Pincode) (Pincode) Telephone No. Pincode (AssesseeCode) (AssesseeCode) (AssesseeCode) (AssesseeCode) (AssesseeCode) (AssesseeCode) (AssesseeCode) (AssesseeCode) (AssesseeCode) (AssesseeCode) (AssesseeCode) (AssesseeCode) (AssesseeCode) (AssesseeCode) (AssesseeCode)

Assessee Code No. Commissionerate Name (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateName) (CommissionerateCode) (CommissionerateCode) (DivisionCode) (Name1) (RangeCode) (RangeCode) Commissionerate Code Division Code Range Code Accounting Code of the Service Amount Tendered in Rupees (AccountingCode1) (AccountingCode1) (AccountingCode1) (AccountingCode1) (AccountingCode1) (AccountingCode1) (AccountingCode1) (AccountingCode1) (Amount1) (Amount1) (Amount1) (Amount1) (Amount1) (Amount1) 0 0 4 4

(Amount1) (Amount1) (Amount1) (Amount1) RECEIVING BANK BRANCH STAMP (Amount2) (Amount2) (Amount2) (Amount2) (Amount2) (Amount2) (Amount2) (Amount2) (Amount2) (Amount2) (AccountingCode2) (AccountingCode2) (AccountingCode2) (AccountingCode2) (AccountingCode2) (AccountingCode2) (AccountingCode2) (AccountingCode2) (AccountingCode3) (AccountingCode3) (AccountingCode3) (AccountingCode3) (AccountingCode3) (AccountingCode3) (AccountingCode3) (AccountingCode3) (Amount3) (Amount3) (Amount3) (Amount3) (Amount3) (Amount3) (Amount3) (Amount3) (Amount3) (Amount3) (AccountingCode4) (AccountingCode4) (AccountingCode4) (AccountingCode4) (AccountingCode4) (AccountingCode4) (AccountingCode4) (AccountingCode4) (Amount4) (Amount4) (Amount4) (Amount4) (Amount4) (Amount4) (Amount4) (Amount4) (Amount4)

0 0 4 4

0 0 4 4

0 0 4 4

(Amount4) (Amount5) (Amount5) (Amount5) (Amount5) (Amount5) (Amount5) (Amount5) (Amount5) (Amount5) (Amount5) (AccountingCode5) (AccountingCode5) (AccountingCode5) (AccountingCode5) (AccountingCode5) (AccountingCode5) (AccountingCode5) (AccountingCode5) (Amount6) (Amount6) (Amount6) (Amount6) (Amount6) (Amount6) (Amount6) (Amount6) (Amount6) (Amount6) (AccountingCode6) (AccountingCode6) (AccountingCode6) (AccountingCode6) (AccountingCode6) (AccountingCode6) (AccountingCode6) (AccountingCode6) (AmountT) (AmountT) (AmountT) (AmountT) (AmountT) (AmountT) (AmountT) (AmountT) (AmountT) (AmountT) Total (AmountWords) (In words) Rupees Only) tender ed by

0 0 4 4

0 0 4 4

(InstrumentNo) (InstrumentDate) (DrawnOn) Cash/Cheque/Draft/Pay Order No.

Dated Drawn on Signature of the Tenderer with date TAX PAYER'S COUNTERFOIL Accounting Code of the Service Amount Tendered in Rupees (AccountingCode1) 0 (AccountingCode1) 0 (AccountingCode1) 4 (AccountingCode1) 4 (AccountingCode1) (AccountingCode1) (AccountingCode1) (AccountingCode1) (Amount1C) (Amount1C) (Amount1C) (Amount1C) (Amount1C) (Amount1C) (Amount1C) (Amount1C) (Amount1C) (Amount1C) RECEIVING BANK BRANCH STAMP (Amount2C) (Amount2C) (Amount2C) (Amount2C) (Amount2C) (Amount2C) (Amount2C) (Amount2C) (Amount2C) (Amount2C) (AccountingCode2) (AccountingCode2) (AccountingCode2) (AccountingCode2) (AccountingCode2) (AccountingCode2) (AccountingCode2) (AccountingCode2) (AccountingCode3) (AccountingCode3) (AccountingCode3) (AccountingCode3) (AccountingCode3) (AccountingCode3) (AccountingCode3)

0 0 4 4

0 0 4 4

(AccountingCode3) (Amount3C) (Amount3C) (Amount3C) (Amount3C) (Amount3C) (Amount3C) (Amount3C) (Amount3C) (Amount3C) (Amount3C) (AccountingCode4) (AccountingCode4) (AccountingCode4) (AccountingCode4) (AccountingCode4) (AccountingCode4) (AccountingCode4) (AccountingCode4) (Amount4C) (Amount4C) (Amount4C) (Amount4C) (Amount4C) (Amount4C) (Amount4C) (Amount4C) (Amount4C) (Amount4C) (Amount5C) (Amount5C) (Amount5C) (Amount5C) (Amount5C) (Amount5C) (Amount5C) (Amount5C) (Amount5C) (Amount5C) (AccountingCode5) (AccountingCode5) (AccountingCode5) (AccountingCode5) (AccountingCode5) (AccountingCode5) (AccountingCode5) (AccountingCode5) (Amount6C) (Amount6C) (Amount6C) (Amount6C) (Amount6C) (Amount6C) (Amount6C) (Amount6C) (Amount6C) (Amount6C) (AccountingCode6) (AccountingCode6) (AccountingCode6)

0 0 4 4

0 0 4 4

0 0 4

(AccountingCode6) 4 (AccountingCode6) (AccountingCode6) (AccountingCode6) (AccountingCode6) (AmountTC) (AmountTC) (AmountTC) (AmountTC) (AmountTC) (AmountTC) (AmountTC) (AmountTC) (AmountTC) (AmountTC) Total Received from Assessee Code No. (AssesseeCodeC) (AssesseeCodeC) (AssesseeCodeC) (AssesseeCodeC) (AssesseeCodeC) (AssesseeCodeC) (AssesseeCodeC) (AssesseeCodeC) (AssesseeCodeC) (AssesseeCodeC) (AssesseeCodeC) (AssesseeCodeC) (AssesseeCodeC) (AssesseeCodeC) (AssesseeCodeC) (AmountWordsC) (In words) Rupees Only (InstrumentNoC) (IntrumentDateC) (DrawnOnC) By Cash/Cheque/Draft/Pay Order No. Dated Drawn on on account of Union Service Tax as detailed in this taxpayer's counterfoil and o n stamp affixed and signed therein.