Printed from www.taxmann.com FORM NO. 27B Form for furnishing information with the statement of collection of tax at source filed on computer media for the period ending __________ (dd/mm/yyyy)* 1. (a) Tax Deduction Account Number (b) Permanent Account Number (c) Financial year (d) Assessment year (e) Previous receipt number (In case return has been filed earlier) 2. Particulars of the collector (a) Name (b) Branch/division (if any) (c) Address Flat No. Name of the premises/building Road/street/lane Area/location Town/City/District State Pin code Telephone No. E-mail Printed from www.taxmann.com 3. Name of the person responsible for collection of tax (a) Name (b) Address Flat No. Name of the premises/building Road/street/lane Area/location Town/City/District State Pin code Telephone No. E-mail 4. Control totals Sr. No. No. of party records Amount paid Rs. Tax collected Rs. Tax deposited (Total challan amount) Rs. Total 5. Total Number of Annexures enclosed 6. Other Information Verification Printed from www.taxmann.com I, ___________________________________________ , hereby certify that all the particulars furnished above are correct and complete. Place: _________ Signature of person responsible for collecting tax at source Date :__________ Name of designation of person responsible for collecting tax at source *dd/mm/yyyy :-date/month/year
