CHALLAN WEST BENGAL POLLUTION CONTROL BOARD

1 CHALLAN CHALLAN . west BENGAL POLLUTION CONTROL BOARD west BENGAL POLLUTION CONTROL BOARD . "Paribesh Bhavan" "Paribesh Bhavan". 10A, Block-LA, Sector-III, Bidhannagar, Kolkata-98 10A, Block-LA, Sector-III, Bidhannagar, Kolkata-98. CLEARING / TRANSFER CLEARING / TRANSFER. PAY-IN- slip PAY-IN- slip . (1st Copy) (2nd Copy). (To be retained at ) (To be sent by the Bank to the west BENGAL POLLUTION CONTROL BOARD ). No .. Date .. No .. Date .. Name of the Unit .. Name of the Unit .. Address .. Address .. Code No. of the Unit .. Code No. of the Unit .. Please Credit Please Credit west BENGAL POLLUTION CONTROL BOARD west BENGAL POLLUTION CONTROL BOARD . A/c. No. 11143637252 with STATE BANK OF INDIA A/c.

2 No. 11143637252 with STATE BANK OF INDIA. Kolkata Main Branch, 1, Strand Road, Kolkata-700 001 Kolkata Main Branch, 1, Strand Road, Kolkata-700 001. Particulars of Assessment Order Particulars of Assessment Order Assessment Order No .. Date .. Assessment Order No .. Date .. Notice No .. Date .. Notice No .. Date .. (In case of Summary Assessment) (In case of Summary Assessment). Due Date of Deposit .. Due Date of Deposit .. Assessed Cess (Current Year) Rs.. Assessed Cess (Current Year) Rs.. (Please Specify Period) (Please Specify Period). Arrear Cess Rs.. Arrear Cess Rs.. Advance Cess Rs.. Advance Cess Rs.. (Please Specify Period) (Please Specify Period). Interest for delay deposit Rs.. Interest for delay deposit Rs.

3 (@ of 2% per month) (@ of 2% per month). Total (in figure) Rs.. Total (in figure) Rs.. Particulars of Cash/Cheque/Draft No.. Date .. Particulars of Cash/Cheque/Draft No.. Date .. Drawn on .. Drawn on .. Rupees (in words) .. Rupees (in words) .. Depositor's Signature Depositor's Signature Scroll No.. Scroll No.. Signature of Receiving Official Signature of Receiving Official CHALLAN CHALLAN . west BENGAL POLLUTION CONTROL BOARD west BENGAL POLLUTION CONTROL BOARD . "Paribesh Bhavan" "Paribesh Bhavan". 10A, Block-LA, Sector-III, Bidhannagar, Kolkata-98 10A, Block-LA, Sector-III, Bidhannagar, Kolkata-98. CLEARING / TRANSFER CLEARING / TRANSFER. PAY-IN- slip PAY-IN- slip . (3rd Copy) (4th Copy).

4 (To be sent by the assesse to the (To be retained by the assesse). west BENGAL POLLUTION CONTROL BOARD ). No .. Date .. No .. Date .. Name of the Unit .. Name of the Unit .. Address .. Address .. Code No. of the Unit .. Code No. of the Unit .. Please Credit Please Credit west BENGAL POLLUTION CONTROL BOARD west BENGAL POLLUTION CONTROL BOARD . A/c. No. 11143637252 with STATE BANK OF INDIA A/c. No. 11143637252 with STATE BANK OF INDIA. Kolkata Main Branch, 1, Strand Road, Kolkata-700 001 Kolkata Main Branch, 1, Strand Road, Kolkata-700 001. Particulars of Assessment Order Particulars of Assessment Order Assessment Order No .. Date .. Assessment Order No .. Date .. Notice No .. Date .. Notice No.

5 Date .. (In case of Summary Assessment) (In case of Summary Assessment). Due Date of Deposit .. Due Date of Deposit .. Assessed Cess (Current Year) Rs.. Assessed Cess (Current Year) Rs.. (Please Specify Period) (Please Specify Period). Arrear Cess Rs.. Arrear Cess Rs.. Advance Cess Rs.. Advance Cess Rs.. (Please Specify Period) (Please Specify Period). Interest for delay deposit Rs.. Interest for delay deposit Rs.. (@ of 2% per month) (@ of 2% per month). Total (in figure) Rs.. Total (in figure) Rs.. Particulars of Cash/Cheque/Draft No.. Date .. Particulars of Cash/Cheque/Draft No.. Date .. Drawn on .. Drawn on .. Rupees (in words) .. Rupees (in words) .. Depositor's Signature Depositor's Signature Scroll No.

6 Scroll No.. Signature of Receiving Official Signature of Receiving Official