Form IX

[See rule 9]
Challan

The Madhya Pradesh Sthaniya Kshetra Me Mal Ke

Pravesh Par Kar Adhiniyam, 1976
[042-Taxes on goods and passengers-Tax on entry of
goods into local areas(M.P.)]

ORIGINAL - To be sent to C.T.O. by the Treasury

DUPLICATE - To be retained by the Treasury
TRIPLICATE - For the Taxpayer to be sent to C.T.O.
QUADRUPLICATE - For the Taxpayer's own Record

Challan of Entry Tax/Penalty/Composition Money Paid to

Government Treaasury/Sub Treasury/Branch of the State Bank of India
By Whom
Tendered

Name and Address of the Dealer on whose behalf money

is paid and R.C.No., Licence No. and Case No., if any.

Payment on account of

[1]

[2]

[3]

Amount
(To be entered in
figure)
[4]

(a) Entry Tax according to Return for the period

FROM
TO
(b)Tax demanded after assessment for the year
(c)Penalty
(d)Interest
(e)Composition Money
(f)Miscellaneous

FOR USE IN TREASURY OR STATE BANK

Total(in Words)

Total

Received payment of Rs. (in figure)_________________________

Rs.(in words)___________________________________________
______________________________________________________
______________________________________________________
Date of entry___________________________________________

Treasurer

Form IX
[See rule 9]
Challan

Accountant

Treasury Officer/Agent or
Manager

Date

Signature of Dealer /Depositer

ORIGINAL - To be sent to C.T.O. by the Treasury

DUPLICATE - To be retained by the Treasury
TRIPLICATE - For the Taxpayer to be sent to C.T.O.
QUADRUPLICATE - For the Taxpayer's own Record

The Madhya Pradesh Sthaniya Kshetra Me Mal Ke

Pravesh Par Kar Adhiniyam, 1976
[042-Taxes on goods and passengers-Tax on entry of
goods into local areas(M.P.)]

Challan of Entry Tax/Penalty/Composition Money Paid to

Government Treaasury/Sub Treasury/Branch of the State Bank of India
By Whom
Tendered

Name and Address of the Dealer on whose behalf money

is paid and R.C.No., Licence No. and Case No., if any.

Payment on account of

[1]

[2]

[3]

Amount
(To be entered in
figure)
[4]

(a) Entry Tax according to Return for the period

FROM
TO
(b)Tax demanded after assessment for the year
(c)Penalty
(d)Interest
(e)Composition Money
(f)Miscellaneous

FOR USE IN TREASURY OR STATE BANK

Total(in Words)

Total

Received payment of Rs. (in figure)_________________________

Rs.(in words)___________________________________________
______________________________________________________
______________________________________________________
Date of entry___________________________________________

Treasurer

Accountant

Treasury Officer/Agent or
Manager

Date

Signature of Dealer /Depositer

Form IX
[See rule 9]
Challan

ORIGINAL - To be sent to C.T.O. by the Treasury

DUPLICATE - To be retained by the Treasury
TRIPLICATE - For the Taxpayer to be sent to C.T.O.
QUADRUPLICATE - For the Taxpayer's own Record

The Madhya Pradesh Sthaniya Kshetra Me Mal Ke

Pravesh Par Kar Adhiniyam, 1976
[042-Taxes on goods and passengers-Tax on entry of
goods into local areas(M.P.)]

Challan of Entry Tax/Penalty/Composition Money Paid to

Government Treaasury/Sub Treasury/Branch of the State Bank of India
By Whom
Tendered

Name and Address of the Dealer on whose behalf money

is paid and R.C.No., Licence No. and Case No., if any.

Payment on account of

[1]

[2]

[3]

Amount
(To be entered in
figure)
[4]

(a) Entry Tax according to Return for the period

FROM
TO
(b)Tax demanded after assessment for the year
(c)Penalty
(d)Interest
(e)Composition Money
(f)Miscellaneous

FOR USE IN TREASURY OR STATE BANK

Total(in Words)

Total

Received payment of Rs. (in figure)_________________________

Rs.(in words)___________________________________________
______________________________________________________
______________________________________________________
Date of entry___________________________________________

Treasurer

FormI IX
[See rule 9]
Challan

Accountant

Treasury Officer/Agent or
Manager

Date

Signature of Dealer /Depositer

ORIGINAL - To be sent to C.T.O. by the Treasury

DUPLICATE - To be retained by the Treasury
TRIPLICATE - For the Taxpayer to be sent to C.T.O.
QUADRUPLICATE - For the Taxpayer's own Record

The Madhya Pradesh Sthaniya Kshetra Me Mal Ke

Pravesh Par Kar Adhiniyam, 1976
[042-Taxes on goods and passengers-Tax on entry of
goods into local areas(M.P.)]

Challan of Entry Tax/Penalty/Composition Money Paid to

Government Treaasury/Sub Treasury/Branch of the State Bank of India
By Whom
Tendered

Name and Address of the Dealer on whose behalf money

is paid and R.C.No., Licence No. and Case No., if any.

Payment on account of

[1]

[2]

[3]

Amount
(To be entered in
figure)
[4]

(a) Entry Tax according to Return for the period

FROM
TO
(b)Tax demanded after assessment for the year
(c)Penalty
(d)Interest
(e)Composition Money
(f)Miscellaneous

FOR USE IN TREASURY OR STATE BANK

Total(in Words)

Total

Received payment of Rs. (in figure)_________________________

Rs.(in words)___________________________________________
______________________________________________________
______________________________________________________
Date of entry___________________________________________

Treasurer

Accountant

Treasury Officer/Agent or
Manager

Date

Signature of Dealer /Depositer