Challan of amount paid into
The ______________ (code No.)
Accounting Collectorate
(Code No.)
Name of the Bank/Branch with
Code No.
_____________________
Division ____________ (Code No.)
Range _____________ (Code No.)
Name of the Focal Point
Bank _____________________
(Code No.) _______________
Name and address of the
assessee
_____________________________
_____________________________
(Code No.
_______________ ) By whom tendered
Full Particulars
of remittance and of authority
Head of accounts
& Major Head (indicate against the appropriate Minor Head)
Accounting Code
No.
By Cash Rs. Ps.
By Cheque Draft / Pay Order etc. Rs. Ps.
Counter Signature of the Departmental Officer (where
required)
Total
(in words) Rs._______________________________________________________________
Date____________________
Signature of the tenderer
(To be filled by the Bank)
Received payment (in word)
Stamp
Rupee__________________________
Space for Focal Point Bank
indicating the date, amount
credited to
Government Account.
Bank's Receipt Stamp:
Signature of the Authorised Officer of the Bank
Name of the Bank_________________
(Please ensure that you have
filled-in the correct details without which the department will not be
responsible for proper adjustment of amount paid by you.)
