Form 27EQ:Quarterly statement of collection of tax at source under Sec 206C for the quarter ended

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Form No.27EQ
[See section 206C and rule 31AA]
Quarterly statement of collection of tax at source under section 206C of the Income‐tax Act for the quarter ended…………………………..(June/September/December/March)………………(Financial year)

1. (a) Tax Deduction and
Collection Account
Number (TAN)
(d) Has the statement been filed earlier for
this quarter (Yes/No)
(b) Permanent Account
Number (PAN) [See
Note 1]
(e) If answer to (d) is "Yes", then Token No. of
original statement
(c) Financial Year (f) Type of Collector (See Note 2)
2. Particulars of the Collector
(a) Name of the Collector
(b) If Central/State Government
Name (See Note 3)
(c) TAN Registration No.
(d) Address
Flat No.
Name of the premises/building
Road/Street/Lane
Area/Location
Town/City/District
State
PIN Code
Telephone No.
Alternate telephone No. (See Note 4)
Email
Alternate email (See Note 4)
3. Particulars 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.
Alternate telephone No. (See Note 4)
Email
Alternate email (See Note 4)
Mobile No.
AIN Code of PAO/TO/CDDO