Quarterly statement of tax deposited in relation to transfer of virtual digital asset under section 393(1) [ Table: S. No. 8(vi)] to be furnished by an Exchange for the quarter ending …

Row No.

Part A: Particulars ofthe Exchange

1.

Name

(refer Note 1)

2.

Address

(refer Note 2)

3.

Permanent Account Number

4.

Email id

5.

Contact number

Country Code

Number

6.

Tax year

Part B: Details of transactions

(i) Details of tax paid with respect of transactions referred to in rule 219(2):

Sl.

No.

Na

me

of

buy

er/

brok

er

Addr

ess

of

buye

r/

brok

er

Perma

nent

Accou

nt

Numb

er of

buyer

/

broker

Nam

e of

the

virtu

al

digit

al

asset

(VD

A)

Date

of

transa

ction

Val

ue

of

VD

A

bou

ght

by

buy

er/

brok

er

Nu

mb

er

of

VD

A

bou

ght

by

buye

r/

brok

er

Total

consider

ation

1% of

total

consider

ation

Date

of tax

paym

ent

Challan details

BS

R

cod

e

of

ban

k

bra

nch

Amo

unt

paid

Cha

llan

seri

al

nu

mb

er

(A)

(B)

(C)

(D)

(E)

(F)

(G)

(H)

(I)=(G)*

(H)

(J)

(K)

(L)

(M)

(N)

1

.

2

.

(ii) Details of transactions on which tax was not deducted in accordance with the guidelines issued under section 400(2)

S

l.

No

Nam

e of

brok

er

Addr

ess of

broke

r

Permane

nt

Account

Number

of

broker

Tax Deduction

and Collection

Account

Number of

broker

Name of

the virtual

digital

asset

(VDA)

Date of

transaction

Value of

VDA

bought

by buyer

Number

of VDA

bought

by buyer

Total

consider

ation

paid/

credited

(A)

(B)

(C)

(D)

(E)

(F)

(G)

(H)

(I)

(J)=(H)*

(I)

1.

2.