Form of intimation on contract/ lease

To
The Assessing Authority,
Gudiyattham East, Gudiyattham

1 Name of the Contractor B&B Builders

2 Complete address of the registered place of business, if the No. 2, 13th East Cross Road
dealer is a registered dealer Gandhi Nagar
Vellore - 632 006

3 TIN/Assessment year 33444242290

4 PAN AAEPB2697M

5 Name of the Contractee and Address Beth-Za-tha /CSI Guidence Centre

Near Palar Bridge, Vellore -632 004

6 Nature of the works contract entrusted Building Renovation (Repair Work)

7 Details of Contract No. contract agreement executed.

8 Period of contract September 2008 to January 2009

9 Total value of the works contract entrusted Rs. 3,23,447/-

10 Bill No. with date as claimed by the dealer (If the payment Nil
is advance amount / part payment, it should be specifically
stated)

11 Total value of the bill passed for payment out of column 9 Rs. 3,23,447/-
above

12 Percentage of tax deduction Nil

13 Amount of tax deducted Nil

14 Details of payment Nil

15 Remarks -

I do hereby declare that the particular furnished above are true correct and complete to the
best of my knowledge and belief
Place : Vellore Signature
Date : status

Designation

ACKNOWLEDGEMENT

Received the statement with proof of remiitance of tax by crossed Demand Draft

or Banker s cheque No dated drawn on

Place : Vellore Signature

Date : Assessing Authority

seal Name

Designation