Statement of Specified Services or E-Commerce Supply or Services

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....                                                                                                                                                                                                                                                       2. ADDRESS                                      ....

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.... YEAR                                       5. WARD/ CIRCLE/ RANGE                                                 (IN RS.) 6. TOTAL AMOUNT OF CONSIDERATION (i) FOR SPECIFIED SERVICES PAID/ CREDITED                                                                                           (IN CASE OF ASSESSEE) (ii) RECEIVED OR RECEIVABLE FROM E-COMMERCE SUPPLY OR SERVICES                                                                     &nbs....

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....sp;                                             PART-B (For Assessee) DETAILS OF EQUALISATION LEVY DEDUCTED PAID TO THE CREDIT OF THE CENTRAL GOVERNMENT Sl. No. Name of the non-resident providing specified service Address of the non-resident referred to in column 2 PAN if, available of non-resident referred to column 2 AADHAAR, if available Amount consideration for specified services paid/ credited Date of payment / credit of amount of consideration for specified services Equalisation levy Interest Penalty BSR Code Challan Sl. No. Date on which amount deposited (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)                                                     PART-B (For E-commerce Operator) DETAILS OF EQUALISATION LEVY&nbs....

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.... 1.  Substituted vide Notification No. 87/2020 dated 28-10-2020 before it was read as, "APPENDIX FORM NO. 1 [See rule 4 of Equalisation levy Rules, 2016] STATEMENT OF SPECIFIED SERVICES EL-1 ACKNOWLEDGEMENT For Office use only Receipt No. Date ....................... ....................... Seal and Signature of Receiving Official                 • Please follow instructions. • Use block letters only. PART-A 1. NAME OF THE ASSESSEE                                                                                                                                                          ....

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....p;                                                                                             3. PERMANENT ACCOUNT NUMBER (PAN)                                                               4. FINANCIAL YEAR (SPECIFIED SERVICE RELATING TO WHICH ARE REPORTED) -                         -               5. WARD/CIRCLE/RANGE                                                 (IN RS.) 6. TOTAL AMOUNT OF CONSIDERATION FOR SPECIFIED SERVICES PAID/CREDITED ....

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....bsp;       12. INTEREST PAID                                                                                           PART-B DETAILS OF EQUALISATION LEVY DEDUCTED PAID TO THE CREDIT OF THE CENTRAL GOVERNMENT Sl. No. Name of the non-resident providing specified service Address of the non-resident referred to in column 2 PAN if, available of non-resident referred to column 2 Amount consideration for specified services paid/ credited Date of payment / credit of amount of consideration for specified services Equalisation levy Interest Penalty BSR Code Challan Sl. No. Date on which amount deposited (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)                               &nbsp....