FORM R STATEMENT OF TAX DEDUCTION AT SOURCE [See rule 9(1) ] To The Assessing Authority ......... I, ......... son of ......., ...(here enter the status/designation) on behalf of Tvl.............(here enter the name with correct and complete address of the person making deduction) hereby remit Rs..... (Rupees............. ...only) by way of tax on works contract, as per the details given below 1 Name of the dealer 2 Complete address of the registered place of business, if the dealer is a registered dealer 3 TIN/Assessment year. 4 PAN 5 Complete address of the place of business/ residence, if the dealer is not a registered dealer 6 Nature of the works contract entrusted (copy of the work order should be furnished) 7 Date of agreement 8 Period of contract 9 Total value of the works contract entrusted Rs. 10 Bill No. with date as claimed by the dealer (If the payment is advance amount / part payment, it should be specifically stated) 11 Total value of the bill passed for payment out of column 9 Rs. above 12 Percentage of tax deduction 13 Amount of tax deducted Rs. 14 Details of payment 15 Remarks I do hereby declare that the particulars furnished above are true, correct and complete to the best of my knowledge and belief. Place : Signature Date : Status Designation Note: 1. The statement shall be filed in duplicate and acknowledgement obtained for the delivery. 2. Separate statement shall be fixed for each Contractor. 3. The remittance shall be made by the mode specified under rule 23 of the Tamil Nadu Value Added Tax Rules, 2007 to the Assessing authority ACKNOWLEDGEMENT Received the statement with proof of remittance of tax by crossed Demand Draft or Banker's cheque No......dated...... drawn on...... Place : Signature Assessing Authority Date Name Seal Designation
