STATEMENT OF PROVISION FOR THE QURATER /YEAR END OF DP CODE 01 STATE NAME 02 VENDOR PAN NO 03 GSTIN OF VENDOR 04 NAME OF THE TAXABLE PERSON / VENDOR 05 Description of supply of goods / services 06 TAXABLE VALUE (EXCLUDING GST) 07 GST AMOUNT ( 08 ) IGST CGST RCM APPLICABLE YES/NO 9 TOTAL VALUE (INCLUDING GST)(7+8) 10 50% of GST COMPONENT 11 (50% of 08) SGST BRANCH NAME DATE MANAGER/Sr. MANAGER EXECUTIVE SIGNATURE AUDITOR SIGNATURE ENTRIES SHOULD BE PASSED IN BSPL PACKAGE 12 (07+11) IT TDS 13 GST TDS 14