Pay-in unit (individual)

Code

00000000

Budget 

account

No.

AW 000000

Full name

XXX

Name

Sales tax

Deposit bank

XXX Branch Savings Counter

Level

District and county level

Account No.

000000000000000000

Which treasury 

the tax pays in

XXX Sub-treasury

Which period of time the tax belongs to: From XXth July 200X to XXth July 200X

Specified paying date:  XXth August 200X

Tax categories/tax items                   Amount charging tax          Tax rate            

Tax amount

Construction and installation               XX                         0.03000             XX

Urban construction maintenance tax         XX                         0.07000             XX

Additional education tax                  XX                         0.03000              XX

Avoid flood tax                         XX                         0.01000              XX

Total amount

(Capital form): RMB XXX yuan

Pay-in unit (individual)

(Seal)

Undertaker (Seal)

Taxation authorities 

Tax Report Center of Local Taxation Bureau of XXX (seal)

Fill-in person (seal)

Amount listed above has been 

and transferred to the receiver’

s accountant

Business Process Seal (3) of 

XXX City Commercial Bank 

Branch,  XXth August 200X 

Seal)

Treasury (bank)’s seal    

month   day   year

Note

RMB XXX yuan