Government Of Sindh

Sindh Revenue Board

Tax Payment Challan Form for Withholding Agent
Sindh Sales Tax Special Procedure (Withholding) Rules,2011 SSTW-04

Month Year

NTN/FTN 0712227-6 Tax Period 03 2019

Name STATE LIFE INSURANCE CORPORATION OF PAKISTAN

Address STATE LIFE BUILDING 9 DR ZIA U DIN AHMED ROAD

Catagory

Total No. Of Service Providers 9 Total Tax Deducted 1,019

Detail of Taxpayers haven been uploaded on ePortal Reference No.31969043

HEAD OF ACCOUNT (B-02384) Sindh Sales Tax on Services

Sr Description Amount
1 Sales Tax on Services (withheld) 1,019

2 Additional Tax / Surcharge / Others 0

3 Arrears 0

4 Penalty / Fine 0

5 Total Amount of Payment 1,019

Amount in words One Thousand Nineteen Rupees And No Paisas Only

Modes & particulars of payment

Sr. Type No. Amount Date Bank City Branch Name & Address

1 Cheque 46656595 1,019 29-Mar-2019 HABIB BANK LIMITED KARACHI STATE LIFE
(CORPORATE)BRANCH,
KARACHI.

DECLARATION OF DEPOSITOR

I hereby declare that the particulars mentioned in this challan are correct to the best of my knowedge and belief.

CNIC F 24 (1) 72

Name STATE LIFE INSURANCE CORPORATION OF PAKISTAN

Create Date 01-Apr-2019 Expiry Date 16-Apr-2019

PSID # : 31969043 Signature of Depositor

Note: This is an input form and should not be signed/stamped by the Bank. A Computerized Paymetnt Receipt(CPR)
should be issued after receipt of payment by the Bank