(See Rule 7 of Service Tax Rules, 1994)








Return of Service Tax credited to the Government of India for the period                       to                       .

Commissionerate :














1. Name of the Assessee :







2. Whether an individual or proprietory firm or partnership firm





    or any other (Please specify)






3. Category of Service    :







4. Service Tax Registration No. :













Name of the taxable service provided


Value of taxable service charged or billed (indicate break-up of the amount month wise)

Value of taxable service realised (indicate break-up of the amount month wise)

Amount of Service Tax payable

Amount of Service Tax adjusted in terms of sub-rule(3)of Rule 6 of Service Tax Rules, 1994 *

Amount of interest payable, if any









































































Details of Payment made to the Government Credit

Mode of payment



Service Tax Credit





Total amount paid



Challan No. and





Date / Journal





Slip No.& Date








Service Tax paid





Interest paid





Any other amount paid **










*   Please specify and enclose documentary evidence.




**  Please specify on what account the amount has been paid









Self assessment memorandum






1. I / We declare that the above particulars are in accordanc with the records and books maintained by us

   and are correctly stated.





2. I / We have assessed and paid the service tax correctly in terms of the provisions of the Act and rules

    made thereunder.





3. I / We have paid duty within the time specified in these rules and in case of delay, I / We have deposited

    the interest leviable as per section 75 of the Act.(Worksheet of interest calculation is attached).











Place :                                                                                 Name and Signature of the assessee

Date  :                                                                                     or his authorised representative













Date of Receipt :










Place :                                                                                    Signature and official seal of the

Date :                                                                                     Superintendent of Central Excise