Single(copy To Be Sent The Zao)

Single(Copy to be sent the ZAO) Tax Applicable(Tick One)* CHALLAN NO./

Assessment Year

(0020) INCOME-TAX ON COMPANIES

ITNS

(CORPORATION TAX)

280

2009-10

(0021) INCOME TAX (OTHER THAN COMPANIES)

Permanent Account Number

AAACE2955M

Full Name

EXPONENTIAL FINANCIAL SERVICES PVT. LTD.

Complete Address With City and State

AN 3 & 3A, SHALIMAR BAGH, DELHI

Tel. No.

Pin

110088

Type of Payment(Tick One) Advance Tax(100)

Surtax(102)

Self Assessment Tax (300)

Tax on Distributed Profits of Domestic Companies(106)

Tax on Regular Assessment(400)

Tax on Distributed Income to Unit Holders(107)

DETAILS OF PAYMENTS

Amount(in Rs.only)

FOR USE IN RECEIVING BANK

Income Tax

debit to A/c /Cheque Credit on

Surcharge Education Cess

DD

Interest

MM

YY

SPACE FOR BANK SEAL

Penalty Others Total

Total(in words) CRORES

LACS

THOUSANDS

HUNDREDS

Paid in Cash/Debit to Ac/Cheque No

TENS

UNITS

Dated

Drawn on (Name of Bank and Branch) Date

Signature of person making Payment

Rs.

Taxpayers Counterfoil(To be filled up by the tax payer ) PAN Received From

SPACE FOR BANK SEAL

AAACE2955M EXPONENTIAL FINANCIAL SERVICES PVT. LTD.

Cash/Debit to Ac/Cheque No

For Rs.

Rs in Words Drawn on (Name of the Bank and Branch)

On Account of Income Tax on Type of Payments

for the Assessment Year

2009 - 10

Code

Rs.