Annexure-IV
GST CHALLAN FORM
CPIN | <<Auto Generated after submission of information>> |
GSTIN | <<Filled in/Auto populated>> |
|
Date | |
Name | <<Auto Populated>> | Email address Mobile No. | <<Auto Populated>>
<<Auto Populated>> |
|
Address | <<Auto Populated>> |
Tax Liability | ||||||
Tax | Interest | Penalty | Others | Total | ||
Government of India | ||||||
CGST | ||||||
IGST | ||||||
Additional Tax | ||||||
Government of <State> | ||||||
SGST | ||||||
Tota | l Challan Amount | |||||
Note :
- Different colors to reduce possibility of data entry errors to be provided.
- Accounting Codes are to be provided for at the backend
Mode of Payment (relevant Portion to become active when selected)
o e-Payment |
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o Authorised Bank OTC | ||||
Net Banking o Credit Card o |
Name of
Receiving Bank ( where |
|||||
Debit Card o |
|
instrument is proposed to be deposited) | ||||
Name of Bank | Name of Branch (Optional) | |||||
Name of
Payment Gateway (in case of payment through CC /DC) |
Name of
City/Town/Village where payment is proposed to be made |
|||||
Details of instrument(optional) | ||||||
Cash o
Cheque o DD o |
Ch/DD
No. |
|||||
IFSC Code | ||||||
Bank | ||||||
Branch | ||||||
Note : Only local cheques ( not outstation cheques to be accepted)
o NEFT/RTGS Remitting Bank |
|
||
Name of Bank |
|
||
Name of Branch | |||
IFSC Code | |||
Name and Code of Beneficiary Bank (RBI and its code) | |||
Name of the
beneficiary account ( Description ‘GST payment’ to be auto Populated) |
|||
Beneficiary Account
Number ( CPIN Auto Populated) |
Note:
- Payments through RTGS / NEFT
- Beneficiary to be defined as the RBI and its account. This would be auto populated by GSTN
- Charges to be over and above Tax amount
Paid Challan Information
Bank Reference No. |
|
Challan Received at | |
CIN | |||
Date of Clearing |
|
||
NEFT/RTGS Unique Ref No. |