'FORM NO. 27
(See rule 37A)
Statement of deduction of tax from interest, dividends or any other sum payable to (i) persons, not being companies, who are non-residents or residents but not ordinarily
residents, and (ii) companies which are neither Indian companies nor companies which have made the prescribed arrangements for the declaration and payment of dividends
within India, for the period ending________________.
1. Particulars of the person making deduction of tax
(a) Name
(b) Address : Flat / Door/ Block No.
    Name of Premises / Building/
    Road / Street / Lane
    Area / Locality /
    Town / District / City
 PIN
State
(c) Tax Deduction Account Number
(d) Permanent Account Number
2.* Has address of the person making deduction of tax changed
 Tick as applicable Yes No
3. Status as defined within the meaning of section 204 read with rule 30 Tick as applicable Central Govt. Others
4. (a) Please tick  the boxes below indicating the section and type of payment (other than "Salaries") made during the year from which tax was required to be deducted at source by you
under the Income Tax Act, 1961
194E 195 196A 196B 196C 196D
193
(b) Please furnish information in separate Annexures as per the enclosed proforma for each type of payment indicated in item (a) above, viz, interest, dividends etc. including the pay-
ments on which no tax has been deducted on the basis of certificate issued by a chartered accountant.
5. Details of tax deducted and paid to the credit of the Central Government
S .  No .
 A mo u n t  D e du c te d Tra n sf e r  Vo u c he r  /   C ha l la n   N o.   g iv e n  b y  Ba n k D a t e  o f   Tra n s f e r V o u ch e r  /  C h a l la n
 B a nk  B ra n ch  C o d e
S e ct io n  C o d e
(1 1 5 )
 (1 1 7 )
 (1 1 8 )
 (1 1 9)
(1 2 0 )
(11 6 )
T ot al
N o t e  -  W he r e  d e d u ct i on   i s  ma d e   b y  o r  on   b e h al f   of   t h e  G o ve rn m e n t ,    t o  g i ve   p a rt i cu la r s  o f  t r an s f e r  vo u ch e rs ;   ot h e r  d e d uc t o rs  t o   g iv e  p a rt i cu l a rs  o f   ch a ll a n  n o .   re g a rd i ng   d e po s it   i nt o   b a n k.
 VERIFICATION
I, _________________________________________________________, hereby certify that all the particulars furnished above are correct and complete.
Place :
 Signature of person responsible for deducting tax at source _____________________________________________________________________
Name and designation of person responsible for deducting tax at source __________________________________________________________
Date :
___________________
* If address has changed give changed address in column 1(b)

Annexure -
Details of............................................................1 paid / credited during the financial year and of tax deducted at source under section2    of Income-tax Act 1961 :-
 A mo u n t  p ay a bl e
 R at e   at
Wh e th e r
Nam e   a nd   A d dr e ss  o f  De d u cte e   (A d dr e ss
 Da te  o n  wh i ch
 D a t e   o n   wh i ch   t a x
 D at e   o n   w h ic h  t a x
Ded uc te e
 Pe rm a n en t   Ac co un t   N um b e r
 B a nk  B ra n ch  C o d e
A mo u n t   of   t a x
ne e d  n o t  b e   gi ve n  i f  P A N  i s  me n t io n e d)
be f o re   d e d uc t io n
w hic h
d e d uc t e d
g ro si n g  u p   is
a mo u nt   pa id /
d e d uc t e d
p a i d  t o  t h e   cre d it   o f
(P AN )  o f   de d u ct e e
C o de 3
o f  ta x
cr e di t e d
t a x
(R s. )
Ce n t ra l  Go ve rn m e nt  5
re q u ir e d 4
d e d u ct e d
( 2)
 ( 3) ( 4 ) ( 5) (6 ) ( 7 ) ( 8 ) ( 9) ( 1 0 )
(1 )
(1 1 )
Notes  : -
1  Please state the nature of payment viz. interest, dividends.
2  Please use separate Annexures for deductions made under different sections.
3  Please enter Deductee Code  01 for companies, 02 for 'other than companies'.
4  Write Y for Yes and N for No.
5  Where deduction is made by or on behalf of the Government, transfer voucher number may be entered in column (9).
6  Write 'A' if deduction is made at a lower rate deduction or no tax deducted is on account of a certificate under section 197 or 195 or write 'B' if on account of certificate issued by a chartered accountant.
7  If necessary, please use additional sheets to give full details of payment in the above format. Please also give running serial number to all pages.
Signature of person responsible for deducting tax at source____________________________________________________________________________
Name and designation of person responsible for deducting tax at source_________________________________________________________________'.

 Annexure -
Details of............................................................1 paid / credited during the financial year and of tax deducted at source under section2    of Income-tax Act 1961 :-
 Re as on f or  non-
D a t e   of   f u rn i sh i ng
de duc t ion  /
Tax  D e du ct i o n
nu m be r  g ive n
lower   deduc t ion
Ce r t if i ca t e
by   b an k
i f  an y6
 (1 4 )
( 1 2 ) ( 1 3 )
C h all an
Signature of person responsible for deducting tax at source____________________________________________________________________________
Name and designation of person responsible for deducting tax at source_________________________________________________________________'.