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ORIGINAL

[See Rule 31(1) (b)] Certificate No. : 94D/08-09/0197110

Name and Address of the Acknowledgement No.s of all Name and Address of the person to
person deducting tax Quarterly Statements of TDS under whom payment made or in whose
sub-section (3) of section 200 as account it is credited
provided by TIN Facilitation Centre
or NSDL web-site

Quarter Acknowledgement No.


ICICI PRUDENTIAL LIFE INSURANCE CO. LTD. Harish Kumar ..
ICICI Pru Life Towers H No19626 Gali No6
1089, 1 021960600015491 Ajit Road
Appasaheb Marathe Marg, Bathinda
2 021960100043895
Prabhadevi,Mumbai-400025 .. Bathinda 151001
3 021960400040445 -/ -/-/9814607130
Code : 00612496
4 To Be Furnished
Br. Code : E89

TAX DEDUCTION A/C NO. MUMI03877G Nature of Payment PAN NO. OF THE PAYEE
OF THE DEDUCTER AONPK1130Q
Insurance Commission
FOR THE PERIOD
PAN NO. OF THE AAACI7351P
DEDUCTER 2008-2009

DETAILS OF PAYMENT,TAX DEDUCTION AND DEPOSIT OF TAX INTO CENTRAL GOVERNMENT ACCOUNT
(The Deductor is to provide transaction-wise details of tax deducted and deposited)

S. Amount Paid / Date of TDS Surcharge Education Total tax Cheque/DD BSR Code Date on Transfer
No. Credited Payment/ Cess deposited No.(if any) of Bank which tax voucher/
Credit Rs. Rs. Rs. Rs. branch deposited Challan
(dd/mm/yy) Identification
No.

1. 5,321.00 483.00 50.00 16.00 549.00

Certified that a sum of Rs. five hundred forty-nine only


has been deducted at source and paid to the credit of the Central Government as per details given in the attached annexure

Place : Mumbai
signature of person responsible for deduction of tax
Date : 30-04-2009
Full Name : MR. SATYAN JAMBUNATHAN
Designation : SVP&HEAD - FINANCE
Certificate No. : 94D/08-09/0197110

S. No. Amount Paid / Date of TDS Surcharge Education Total tax Cheque/DD BSR Code Date on Transfer
Credited Payment/ Rs. Cess deposited No.(if any) of Bank which tax voucher/
Credit branch deposited Challan
(dd/mm/yy) Identification
No.
1 4125.00 30-09-2008 0.00 0.00 0.00 0.00 0 6390340 07-10-2008 00745
2 96.00 31-03-2009 10.00 1.00 0.00 11.00 0 6390340 08-04-2009 00924
3 1100.00 31-03-2009 473.00 49.00 16.00 538.00 0 6390340 15-04-2009 00227

5,321.00 483.00 50.00 16.00 549.00


Certificate No. : 94D/08-09/0197110

S. No. Amount Paid / Date of TDS Surcharge Education Total tax Nature
Credited Payment/ Rs. Rs. Cess deposited
Credit Rs. Rs.

1 4125 30-09-2008 0 0 0 0.00 Commission Payout in September 2008


2 96 31-03-2009 10 1 0 11.00 Xv-1050659Harish Kumar ..Super Inning-Rural
AdvisorIpru Branded Diary
3 1100 31-03-2009 473 49 16 538.00 Commission Payout in March 2009

5,321.00 483.00 50.00 16.00 549.00

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