FORM NO. 27A              
        Form for furnishing information with the statement of deduction of tax at
     source filed on computer media for the period (From           to           )
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   1. | (a) Tax Deduction Account Number                                         | 
      | (b) Permanent Account Number                                             | 
      | (c) Form No.                                                             | 
      | (d) Financial  Year                                                      | 
      | (e) Assessment Year                                                      | 
      | (f) Previous receipt number                                              | 
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   2. Particulars of the deductor
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      | Name                     |                                               | 
      | Type of deductor         |                                               | 
      | Branch / Division        |                                               | 
      | Address                  |                                               | 
      |                          |                                               | 
      |                          |                                               | 
      |                          |                                               | 
      |                          |                                               | 
      | State                    |                                               | 
      | Pin Code                 |                                               | 
      | Telephone No.            |                                               | 
      | E-mail                   |                                               | 
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   3. Name of the person responsible for deduction of tax
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      | Name                     |                                               | 
      | Address                  |                                               | 
      |                          |                                               | 
      |                          |                                               | 
      |                          |                                               | 
      |                          |                                               | 
      | State                    |                                               | 
      | Pin Code                 |                                               | 
      | Telephone No.            |                                               | 
      | E-mail                   |                                               | 
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   4. Control Totals
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      | Sr. |No. of deductee|  Amount Paid   | Tax deducted |    Tax deposited   | 
      | No. |/ party records|     (Rs.)      |     (Rs.)    |        (Rs.)       | 
      |-----|---------------|----------------|--------------|--------------------| 
      |  1. |               |                |              |                    | 
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   5. Total Number of annexures enclosed
   6. Other Information

                                       VERIFICATION                                       
      I,                                                                          
      hereby certify that all the particulars furnished above are correct and complete.


      Place :                                       ................................
      Date  :                                       Signature of Person responsible
                                                    for deducting tax at source
                                    Full Name    : ............................
                                    Designation  : ............................