FORM ST-3

(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

Month(s)

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

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Details of Payment made to the Government Credit

Mode of payment

Cash

Service Tax Credit

(8a)

(8b)

Total amount paid

Amount

Challan No. and

Amount

(8a+8b)

Date / Journal

Slip No.& Date

Service Tax paid

Interest paid

XXXXXXXX

Any other amount paid **

XXXXXXXX

*   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

Acknowledgement

Date of Receipt :

Place :                                                                                    Signature and official seal of the

Date :                                                                                     Superintendent of Central Excise