Account office name * Accounts Office Address * Address 1* Address 2 Address 3 Address 4 City * State * PIN code * ID * STD code Phone No *

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] FORM NO. 24G [See section 30 and rule 37CA] TDS/TCS Book Adjustment Statement Details transfer voucher for the month ending (month) mm (year) yyyy 1. Accounts Officer details Accounts Officer Identification Number (AIN) Account fice name Accounts Office Address Address 1 Address 2 Address 3 Address 4 City State PIN STD -Phone 2. Responsible persons details (see note 1) Responsible persons name Responsible persons designation Responsible persons Address Address 1 Address 2 Address 3 Address 4 City State PIN STD Phone No 3. Type statement Has the statement been filed PAO registration Number Mobile the responsible person Printed from www.incometaxindia.gov.in Page 1 5

earlier for this month (Yes/No) If answer to above is Yes, then provisional receipt original statement 4. Category Deductor for whom statement is being submitted : Central/State Government State Ministry 5. wise details transfer Vouchers 5a wise details TDS-Salary (24Q) registration Sub-Ministry Address 1 Address 2 Address 3 Address 4 City State PIN 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 5b. amount transferred for TDS Non-Salary (26Q) registration Address 1 Address 2 Address 3 Address 4 City State PIN 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 5c. amount transferred for TDS Non-Salary (27Q) registration Address 1 Address 2 Address 3 Address 4 City State PIN 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 5d. amount transferred for TCS (27EQ) registration Address 1 Address 2 Address 3 Address 4 City State PIN 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 Printed from www.incometaxindia.gov.in Page 2 5

6. Statement Summary: Count Distinct s entries in item 5 amount reported (AG/Pr CCA) Verification I hereby certify that all the particulars furnished above are correct and complete. Place: Signature the person responsible (see note 1) Date: Notes : 1. Responsible person is the person made responsible in the fice Pay and Accounts Officer (PAO) or Treasure Officer (TO) or Cheque Drawing and Disbursing Officer (C) for filing this form. 2. Payments pertaining to all the nature payment TDS-Salary (24Q)/TDS Non-Salary (26Q)/TDS-Non-Resident (27Q)/TCS (27EQ) to be furnished in same form. 3. Furnishing either registration or is mandatory 4. There can be maximum four entries (Nature deduction wise) per in every month. 5. This form shall be applicable only in respect tax deducted/collected on or after 1st April, 2010. 6. The fields marked as are mandatory. 7. Details Ministry Sr. Ministry 1 Civil 2 Railway 3 Defence 4 Telecommunication 5 Post 6. Details Sub-Ministry (in case Civil Ministry) Sr. Sub-Ministry name 1 Agriculture 2 Atomic Energy 3 Fertilizers 4 Chemicals and Petrochemicals 5 Civil Aviation and Tourism 6 Coal 7 Consumer Affairs, Food and Public Distribution 8 Commerce and Textiles 9 Environment and Forests and ministry Earth Science 10 External Affairs and Overseas Indian Affairs 11 Finance 12 Central Board Direct Taxes Printed from www.incometaxindia.gov.in Page 3 5

13 Central Board Excise and Customs 14 Controller Aid Accounts and Audit 15 Central Pension Accounting Office 16 Food Processing Industries 17 Health and Family Welfare 18 Home Affairs and Development North Eastern Region 19 Human Resource Development 20 Industry 21 Information and Broadcasting 22 Telecommunication and Information Technology 23 Labour 24 Law and Justice and Company Affairs 25 Personnel, Public Grievances and Pensions 26 Petroleum and Natural Gas 27 Plannning, Statistics and Programme Implementation 28 Power 29 New and Renewable Energy 30 Rural Development and Panchayati Raj 31 Science and Technology 32 Space 33 Steel 34 Mines 35 Social Justice and Empowerment 36 Tribal Affairs 37 D/o Commerce (Supply Division) 38 Shipping and Road Transport and Highways 39 Urban Development, Urban Employment and Poverty Alleviation 40 Water Resources 41 President's Secretariat 42 Lok Sabha Secretariat 43 Rajya Sabha secretariat 44 Election Commission 45 Andaman and Nicobar Islands Administration 46 Chandigarh Administration 47 Dadra and Nagar Haveli 48 Goa, Daman and Diu 49 Lakshadweep 50 Pondicherry Administration 51 Pay and Accounts Officers (Audit) 52 Non-conventional energy sources 53 Government NCT Delhi 54 Others 7. Details State 1 Andaman and Nicobar Islands Printed from www.incometaxindia.gov.in Page 4 5

2 Andhra Pradesh 3 Arunachal Pradesh 4 Assam 5 Bihar 6 Chandigarh 7 Chattishgarh 8 Dadra & Nagar Haveli 9 Daman & Diu 10 Delhi 11 Goa 12 Gujarat 13 Haryana 14 Himachal Pradesh 15 Jammu & Kashmir 16 Jharkhand 17 Karnataka 18 Kerala 19 Lakshwadeep 20 Madhya Pradesh 21 Maharashtra 22 Manipur 23 Meghalaya 24 Mizoram 25 Nagaland 26 Orissa 27 Pondicherry 28 Punjab 29 Rajasthan 30 Sikkim 31 Tamilnadu 32 Tripura 33 Uttar Pradesh 34 Uttaranchal 35 West Bengal Printed from www.incometaxindia.gov.in Page 5 5