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GST Challan Form (Annexure-IV)

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 :

  1. Different colors to reduce possibility of data entry errors to be provided.
  2. Accounting Codes are to be provided for at the backend

Mode of Payment (relevant Portion to become active when selected)

 

o e-Payment  

 

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:

  1. Payments through RTGS / NEFT
  2. Beneficiary to be defined as the RBI and its account. This would be auto populated by GSTN
  3. 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.  

 

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