1. | Name of the assessee cccccccccccccccccccc |
2. | Registration Numbers of premises for which return is being filed cccccccccccccccccccc |
3. | Category of taxable services for which return is being filed: (Mention all the taxable services provided/received) (1)________________________________ (2)________________________________ (3)________________________________ |
4. | Payment of Service Tax Category of Service: __________________________________________________ |
Apr/Oct | May/Nov | June/Dec | July/Jan | Aug/Feb | Sept/Mar | Total of column (2) to | |
(1) | (2) | (3) | (4) | (5) | (6) | (7) | (8) |
Amount received towards taxable service(s) provided | |||||||
Amount received in advance towards taxable service(s) to be provided | |||||||
Amount Billed- gross | |||||||
Amount billed for exempted services other than export | |||||||
Amount billed for exported services, without payment of tax | |||||||
Amount billed for services on which tax is to be paid | |||||||
Abatement claimed- Value | |||||||
Notification number of Abatement | |||||||
Notification number of exemption | |||||||
Provisional Assessment order no. | |||||||
Service tax payable | |||||||
Education cess payable | |||||||
Service tax paid in cash | |||||||
Challan Number | |||||||
Challan date | |||||||
Service tax paid through cenvat credit | |||||||
Education cess paid in cash | |||||||
Education cess paid through education cess credit |
Amount-Cash | Challan Number | Date | Amount-Credit | Source Document No | |
(1) | (2) | (3) | (4) | (5) | (6) |
Arrear of service tax | |||||
Education cess | |||||
Interest | Not applicable | ||||
Penalty | Not applicable | ||||
Miscellaneous | Not applicable | ||||
Excess amount paid and adjusted subsequently** | |||||
Total |
Details of Credit | Apt/Oct | May/Nov | June/Dec | July/Jan | Aug/Feb | Sept/Mar |
(1) | (2) | (3) | (4) | (5) | (6) | (7) |
Opening Balance | ||||||
Credit availed on inputs | ||||||
Credit availed on capital goods | ||||||
Credit availed on input services | ||||||
Credit received from inputs service distributor | ||||||
Total credit availed | ||||||
Credit utilized towards payment of service tax | ||||||
Closing balance |
Details of Credit | Apt/Oct | May/Nov | June/Dec | July/Jan | Aug/Feb | Sept/Mar |
(1) | (2) | (3) | (4) | (5) | (6) | (7) |
Opening Balance | ||||||
Credit of education cess availed on goods | ||||||
Credit of education cess availed on services | ||||||
Credit of education cess utilized for payment of service tax | ||||||
Closing Balance |
Details of Credit | Apt/Oct | May/Nov | June/Dec | July/Jan | Aug/Feb | Sept/Mar |
(1) | (2) | (3) | (4) | (5) | (6) | (7) |
Opening Balance | ||||||
Credit of service tax received | ||||||
Credit of service tax distributed | ||||||
Credit of service tax not eligible to be distributed* | ||||||
Closing Balance |
Details of Credit | Apt/Oct | May/Nov | June/Dec | July/Jan | Aug/Feb | Sept/Mar |
(1) | (2) | (3) | (4) | (5) | (6) | (7) |
Opening Balance | ||||||
Credit of education cess received | ||||||
Credit of education cess distributed | ||||||
Credit of education cess not eligible to be distributed* | ||||||
Closing Balance |
(Name and Signature of Assessee or Authorized Signatory)
(Signature of the Officer of Central Excise & Service Tax)
(With Name & Official Seal)”
(R. Sriram)
Deputy Secretary to the Government of India
(F.No. 137/44/2004-CX.4)