“FORMNO.15G {See sestion 197A(), 197ACLA) end rue 29C] Declaration under seetion 197A (1) and section 197A(1A) to be made by an individual ora person (not being a company or firm) claiming certain incomes without deduction of tas. PARTI T Nene of Asesee Decl) T PAN ofthe Asse 3 Sen Breau year © Residential Sane (Gor schich destaration i bing mde) ‘SFin Doar Bisck No] 7 Name of Premier S Road Seeaiase |S AnaLealy To TomGay Dame [Tr See TZN 15 Ema Ta Teisphens No, GST [15 (@) Wietherasewedvo ar imdarthe Ye Ne Code) and Mile No, Tncome-tas Act, 1961: oo (© yes, latest assessment year for which seed Te Etinatedtacne for wc eslaration made | 17. Evinted total tocont of he FY ta wiih ‘come mentioned in colin 160 beinctaded™ TS, Detal of Fann No, 1SGother haa tls fon Bled dung the previous year, Fay’ Total No, of For No, 180 led ‘Aggregate amount of income for wich Foam No.1SG fied 1D, Details of income for whic the deslastion ie Sled SL | Wdetisestion muuber of relevant | Nature ofliconie | Section wader which tax | Amount ofimcome No. | investment account i is dedctible ‘Simature of te Declara® Declaration'Verification”” “UW. do hereby declare tat to the best of *my’our knowledge and belief what is stated above is comect coniiete and i wuly stated. "UWe declare that dhe incomes refered to inthis form are nat ‘clube in the total income of any oxher person under setons 60 ro 64 of the Inoote-ak Act, L961. “TW further lesa tat the tax "ou myour estimated total income including “income incomes refered to in coh 16 “and ‘aggregate amonnt of “income incomes refered to in eohunn 18 computed in accordance with the provisions ofthe lnsonie-iox Act, 1961, forthe previous year ending Of osnnwonesFelevaut fo the SBSeSBEO Yea? oven bre nil “We also declare tnt "ay oar income somes to ia cohume 16 "and the agaregstesmcnar of *ingome!incomes refered tin colin 18 for the previous year ending 09...» Relevant fo the assessment year ‘vill not exseed the marin ametnt which isnot charzesle Yo incomestn, Pose: Signa ofthe Desirant™ Date: PARTI [To be filled by the person responsible for paying the income referred to in column 16 of Fart I) T Namie of ie paeon rerponble for paying J. Unique Menifienion Ne SPAN of the penon | Complete Adio 3. TAN ofc ponon rponsblefopaying responsible for paying Enna 7 Telephone No (ii STD Cok) and Mobile No] 8 Amnouit oF incane pald™ 9. Date oa whisk Devlation i yescived | 10, Date on whish the imome las been paid credited (DDMMYYYY) (DDMMYYYY)Place: ‘Siguatue of the person responsible for paying Date: the income referred to in column 16 of Part T ‘Delete whichever isnot applicable "As per provisions of section 206AA(2), the declaration under section 197(1) or 197A(IA) shal be invalid ifthe declarnnt fils to fiumish his valid Permanen: Account Number (PAN). "Declaration can be fisished by an individual under section 197(1) and a person (other than @ company’ ora fim) der sestion 197A(LA), The financial year to which the income pert. ‘Please mention the residential stats as per ‘he provisions of section 6 of the Income-ax Act, 1961. * Please mention “Yes” if assessed to tax under the provisions of Income-tax Act, 1961 for any of the assessment yest ontof sx sssesnent years prceing te yea in which the deslrtin is Hed Please mention the amount of estinated tol income of the previous year for which the declaration is filed including the amount of income for which ths declaration is made Jn ease any deslaration(s) in Form No. 15G is filed before filing this declaration ding the previous year, mention the total number of such Form No. 18G fled slong with the agaregete amount of income for which seid declaraton(s) have been filed SMention the distinctive mumber of shares, account suunber of term deposit. rectring deposit. National Savings ‘Schemes, life insurance policy number, employee code, ct, Sindiate the capacity in which the declaration is famished on behalf of a HUF, AOP, es "Before siging the declaration’verification. the declarant should satisfy himself that th information furnished in {his form is tru, correct and complete in ll respects. Any person making a fale statement in the declaration shall be liable ro prosecution under section 277 ofthe Encome-tax Act, 1961 and on conviction be punishable- (in case where tax sought to be evaded exceeds twenty-five lakh mypees, with rigorous impriscament ‘which shall not be less than six moaths but which may extend to seven years and with fine; (i) in aay ote case, with sigorous imprisonment which shall not be less than three months but which may extend to two years and wth fine "The person responsible for paying the income referred to in colunn 16 of Pat T shal allot a unique identification smumber to all the Form No. 15G received by him during a quarter of the financial year and report this reference number along wth the particulars presribed in male 31A(4)(vi) ofthe Income-tax Rules, 1962 inthe TDS statement furnished for the same quarter. In case the person has also received Form No.1SH during the seme quater, please allot separate seis of serial mnuber for Fora No.15G and Fors No.15H. "The person responsible for paying the income seized to in column 16 of Part I shall not accept the declaration where the amount of income of the nature referred to in sub-section (1) or sub-section (1A) of section 197A or the agaregate ofthe amounts of such income credited or paid or likely to be credited or paid doing the previons year in ‘whieh such income is to be included exceed the maximsm amount which is not chargeable to tax, For deciding the cligibity, he is required to verify income or the aggregate amount of incomes, as the ease may be, reported by the declarnat in columns 16 and 18.