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FORM ST-3A* Memorandum for provisional deposit under rule 6 of the Service Tax Rules, 1994,

For the month of ______ 20__

Sl. Provisional Provisional Form Actual No value of amount of TR-6 value of taxable service tax No. taxable service in ~{***} paid and service in terms of date terms of section 67 section 67 of the Act 1 2 3 4 5 Actual Difference Form TR- Remarks amount between the 6 No. and of amount of date service provisionally indicating tax paid tax and payment payable the amount under of service column tax payable (7) 6 7 8 9

Reasons for making provisional deposit of Service Tax _________ * Attach separate sheet for each month.