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

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

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