Form No.

27 A
Form for furnishing information with the statement of deduction of tax at source filed on computer media for the period

From : 01/04/2010 To: 30/06/2010

1. (a) Tax Deduction Account Number : PTLS11234L (d) Financial Year : 201011
(b) Permanent Account Number : BGEPS2753M (e) Assesment Year : 201112

(c) Form Number : 26Q (f) Previous receipt number :

2. Particulars of the Deductor / Collector 3. Name of the person responsi

(a) Name SARPAL & ASSOCIATES (a) Name NAVDEEP SARPAL

(b) Type of Deductor Central Government (b) Address

(c) Branch / Division (If Any) Flat No. H.L. 428, PHASE-9,
(c) Address Name of premises/building
Flat No. H.L. 428, PHASE-9, Road / Street / Lane MOHALI
Name of premises/building Area / Location
Road / Street / Lane MOHALI Town / City / District MOHALI

Area / Location State

Town / City / District MOHALI Pin Code 160062
State PUNJAB Telephone Number 0172223448
Pin Code 160062 Email

Telephone Number 0172223448

Email

4. Control Totals

Sr. No. No. of Deductee / Party Amount Paid Tax deducted / Collection Tax deposited (Rs.)
(Rs.) (Rs.) Total challan amount

Total 0 00.00 00.00 12340.00

5. Total Number of Annexures enclosed :

6. Other Information :

I,______________________________________________,hereby certify that all the particulars furnished above are correct and complete.

Place : Signature of person responsible for deducting tax at source__________________

Date : Name and designation of person responsible for deducting tax at source_________________
me of the person responsible for deduction / collection of tax

VDEEP SARPAL

. 428, PHASE-9,