Certificate of Collection of Tax

(Name and address of the person or the office of the person issuing the certificate)

(office letterhead may be used)

Certificate of Collection of Tax

[section 58 of the Income Tax Ordinance, 1984 (XXXVI of 1984)]

No.		Date
01	Name of the person from whom tax has been collected
02	Address
03	Does the person have a Twelve-digit TIN?		Yes	No
04	Twelve-digit TIN (if answer of 03 is Yes)

05. Particulars of tax collection (add lines if necessary)

Sl	Date of Collection	Description of collection of tax	Section	Amount of tax collected ৳	Remarks
1
2
Total

06. Payment of collected tax to the credit of the Government (add lines if necessary)

Sl	Challan* Number	Challan date	Bank Name	Total amount in the challan ৳	Amount relating to the this certificate ৳	Remarks
1
2
Total
In words:

*if payment is made in any other mode specified by the Board, provide information relevant to that mode.

Certified that the information given above is correct and complete.
Name of the person issuing the certificate	Signature and seal
Designation
TCAN
Phone & E-mail	Date