FoR NO.356 [seesection 19781), 1978(38) ad re 290) ‘Declaration undor section 197A and seston 1S7ALA) af the Icome tax Aet, 196 tobe made by an individual oa person oot in company o fen) eating extain receipt without deduction ofa Pant Fi-Wame of Asesse (Bacon) SANTOSH Rumer. Paar the Ase [assessment Year {tor wnien éecarations bring made) [Fees he, [Nae ania eat IH Ramassa, GORDLU Fn me WE Tose JP Rsrocany ta eostanaer a TT ‘), |_Nea2 Revo, ScHeoe helbheor Cade] Te Rae Ce RON, fic ouvert RANeaLeRe ikarw A, Shook? les HSE Helene Neh S70 Coejand Woble a. 7 re Wace ae esdenal Sts wate Nam of BacneOcapati Jneaningor section 6 the income Tax fac.isen Trent RO WSS BRET [Trt Cit Cormsioner oleae tx or Cormisineroncometax i nt oicned to Pwo Cata] Gp [ange Cae. Income ox eats) [2 stimsted toalincome From the sores toned alo L (essa the eB) iene rom ares eared tin Sched Interest on secures refered on Sched Inte on se referred in Schl Trzoms for ute refed to Sched “he Ooo whdrawal eric on soon BOCOATV) om Nana Sawing Scheme efrred toi Sede Blodog (5 inst tance othe prev "ews income mertined a Golun 92 to be na ude 24, otal of investments in rope of which the decision sng made: ‘sonoutes (tata shrew stdin rae fhe Gat and ny owned yn) Mao | Gumatibaret | arene Sure | teen ofeach |S] ance mmbersothestaes | Oates on wich the shes were acute te ae ern sevsoutea (nett fhe cate dnt amet dean anneal une in) ectenst | wenperotacwies | amoreetseumes | mnt ipanion whch nsec wee anne om ee Megaed byte dadanly screouten {eas of te sums ven ty she detrant on tres) ame ang aces ofthe | Amount | poteonwhieh thesumsweregvenen | Pevodforuhichnmewere | Rate senelositon the mum ore,| aengen fntees/mm ivy) ivenoninerest. | inert Guenonintrest” | on terest soeoueN (Cet ofthe mutual urd units held inthe nae of declarant and beefy owned by him) ane and wlireasof the | wumber oF] Cass of unis and face vaieaFeath |e umber ony [AMOR TOTAT A ual fund nts wt a el nite scrote (Dez of the withdrawal mado from Maton Svig: hems) Panic ofthe Post ofce where the account under the National SavngeScheme| Date on which the account |The amounto Icmabtined ad the account rember ‘was opened) |NCrwl e Berea. evel fzor, FO Printed from wow incometaxindia gov.in Page 1 of 2“we SAN TEED H.d needy dere that to thebestof my/our lnowedge an beet what stated ave conrect, om capt —— “Signature ofthe Decorant Declratar/Venteation to andi ey stood. We decors that he incomes refered ton this form are not iudsein the total income oF any oer person Ws 60 a Ge te ncometax Act 861, We fre, ‘declare hat the tax “on my/our estimated toa income, including “ncomelineamesafrodo i oly 22 abo, comptes accordonc with te provers lb i "We ae, dere tat "your ‘it ne exceed the makin fhe come ace, 1961 forthe aeewous yearend “incomesincmesreterredton Colin 22 fo the prowows yer ening on amount whieh snot charges ta ince, Pisce: BANA tLe As one esehesferctt arin relevant tothe aeasrent yer relevant othe statement yer exten i Sienature ofthe beara [for wse by the person to whom the cecaretion fried) [i are othe parson responsible Tor paying te ome refered wn Cokin 22 f Park [2 Pave the parson ndlested a Column afar Gols? SoS, osfec)aei4- compe nae 7 Kes Crgiteer® Iz TA ofthe peso inated n Column TaRPart YONENMOA Donn plepe- LE [emer 5 Tene Noe Code = ees" isa I Das on wich oeiratons arid —[-PoRGU Hpac wich he es Tavbneh io ran olin Id Daca TSE |sarnenrr sere ort income as evn puted psa tion Songs Schre(4mmivn [i Date of declaration, derbaon or payment of aidcndlwihdrawal order We Joeen mace [5 Account Noe o National Sng Schone om Which witha ie Jowqioge Iq Forwarded othe Cit Commissioner er Commision of nem nn The detoratin shouldbe furnished in dupe et whichever ot spate. ‘ocleaton con be fre by an individu under sation 15783) and a person (ote hana company 3 fem] under sction TS7AA ‘incete the cape In whch the deca funsnes on bea os UF, AOD ee Before signing the decaration/ veto the declarant should sais hrmsel that the formation fred inthis frm stu cocrct nd eompet i al respects. Ay person making ase statement nthe dear sal beable to prosecitionsder277of the lnce-tax At 1961 aon conon be punishable |} In case where tax soup oe evaded exceeds twenty ve lth rypets th rigorous imprikanent which shal ot be les han 6 months but which ‘may eter to seven yearsand with ne, 1) tnany other cae th rigorous ingrionmen which cl nt be es than? months but which may exert wo yest i wt fie. ‘The person responsible fr payin the income refered fo col 22 of Parshall nt accept the dectration where ths aroun of income ofthe nator referred ‘oin subsection 1 or sub-section (1A of section 187A the agaregate ofthe amounts of sch income credited pide ely tobe ected rp cing the Previous yearn which uch income sto be inde exced the maximum amour whichis ot chargeable to tax" Printed from wav incometaxindia.gov.in Pogo 20f2