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FORM NO.

27A
Form for furnishing information with the statement of deduction/collection of tax at source (tick which ever is applicable) filed
on computer media for the period from 01/01/2010 to 31/03/2010 (dd/mm/yyyy)#

1. (a) Tax Deduction Account No. DELM09780B

(b) Permanent Account No.


(c) Form No. 26Q
(d) Financial Year 2009 - 10
(e) Assessment year 2010 - 11
(f) Pervious receipt number
(In case return/statement has been filed 060940400373521
earlier)
2. Particulars of deductor

(a) Name MINISTRY OF HEALTH & FAMILY WELFARE

(b) Type of deductor * Government


(c) Branch/division (if ---
any)
(d) Address
Flat No. 4TH FLOOR

Name of the premises/building NIRMAN BHAWAN

Road/street/lane MAULAN AZAD ROAD

Area/location
Town/City/District NEW DELHI

State DELHI

Pin code 110001

Telephone No.

E-mail
3. Name of the person responsible for deduction/collection of tax
(a) Name K R Verma
(d) Address
Flat No. 4TH FLOOR

Name of the premises/building NIRMAN BHAWAN


Road/street/lane MAULAN AZAD ROAD

Area/location
Town/City/District NEW DELHI

State DELHI

Pin code 110011

Telephone No.
E-mail
4. Control totals

Sr. No. No. of deductee/ Amount paid Tax deducted/collection Tax deposited (Total challan
party records Rs. Rs.. amount)
Rs.
1 1 10969335.00 994500.00 994500.00
Total 1 10969335 994500 994500
5. Total Number of Annexures enclosed 0
6. Other Information

Verification
I, ASHA PRASAD, hereby certify that all the particulars furnished above are correct and complete.

Place : NEW DELHI

Date : 20-Sep-2010 Signature of person responsible for


deducting/collecting tax at source
* Mention type of deductor - Government or Others
Name and designation of person responsible K R Verma, DDO
# dd/mm/yyyy :- date/month/year for deducting/collecting tax at source