FORM ST. XI CHALLAN (To be retained by the dealer) Treasury/Sub-Treasury/Branch of State Bank of India or the State Bank of Patiala. District _______________________________________________________________________ (i) By whom tendered _________________________________________ (ii) Name, address and Registration No. of dealer on whose behalf money is paid. _____________________________________________________ Received the sum of Rupees _______________, on account of ____________ (__________Tax)/ Penalty/(Interest)/Composition money/Registration Fee/Other Fees for the period from _________ to ________________ and credited under the Head of Account (0-40-Sales Tax) - Receipts under the Punjab General Sales Tax Act. Treasury/Treasury Officer/Sub-Treasury Officer/Agent, State Bank of India/Manager, State Bank of Patiala. Dated ___________ 19 ______________
