FORM NO. 27A 
Form for furnishing information with the statement of deduction/collection of tax at source (tick whichever is applicable) filed
on computer media for the period (From 	 to 	 (dd/mm/yyyy)#
1.   (a) Tax Deduction Account No.
(b)	Permanent Account No.
(c)	Form No.
(d)	Financial Year
(e)	Assessment year
(f)	Previous receipt number
(in case return/statement has been filed earlier)
2. Particulars of deductor/collector
(a)	Name
(b)	Type of deductor*
(c)	Branch/division (if any)
(d)	Address Flat No.
Name of the premises/building
Road/street/lane
Area/location
Town/City/District
State
Pin code Telephone No. E-mail

3.	Name of the person responsible for deduction/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 deductee/ party records	Amount paid Rs.	Tax deducted/collection Rs.	Tax deposited (Total challan
amount)
Rs.	
					
Total					
5.	Total Number of Annexures enclosed
6.	Other Information
Verification

I, 	 , hereby certify that all the particulars furnished above are correct and complete.
Place: 		Signature of person responsible for
deducting/collecting tax at source
Date : 		Name of designation of person responsible for
deducting/collecting tax at source *Mention type of deductor - Government or Others #dd/mm/yyyy :-date/month/year