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DECLARA TION
having Permanent Account NEmber (PAN) AELP S 5797M hereby declare the following:
a. I am aware ofthe provisions ofTDS狐d TCS u/s 194Q, 206C(1H), 206AB and 206CCA.
( 捜 I NO )
c. Ifanswer to `b, above is ``YES”, l / we confirm to timeIy deposit TDS u/s 194Q with the govemment and submit the TDS
ce輔cates to BPCし. MyTAN* is BしRB16686F and copy / copies a「e a舶Ched herewith for ve「ification. (No need t6 give
d. I / We hereby agree to indemnrty BPCL in case offailure on compliance ofthe provisions ofTDS u/s 194Q or no正ssuance
of TDS certificate or both, I / We shall be liable to pay BPCL the TCS u/s 206C (lH), along with applicable interest and
Penalty incurred by BPCL for delay in deposit ofTCS u/s 206C(1H).
lTR軸edforthefinanciaiyear2018-19 Yes/No:YES
lfYes,mentionlTRacknowiedgementnumber
lTR相edforthefinanciaIyear2019-20 Yes/No:YES
IfYes,mentionlTRacknow!edgementnumbe「
WhethertotalofTDS&TCSofFY2018-19was=与0,000ormore Yes/No:YES
Whethe「totaIofTDS&TCSofFY2019-20was=50,000ormo「e Yes/No:YES
f I / We also agree to indemnify BPCL in case ofany liability which may arise consequent to any e∬Or Or nOn-adherence to
g. I hereby declare that I am duly authorized to sub血t and sign this declaration・
Yours Faithfully
For BG SHIVAPRAKASH MⅢ
軽重垂垂: D圏A鵬R
B.G. §HIVAPRAKASH嗣RJI
戸OrB. G.SHI Dealers : B.P.C.しtd.,
Sig血a皿d Se血
Batawadi, B. H. Road,
丁UMKUR ・ 572 103.
四囲
費In case of皿ultiple TANs, Plcase provide only the TAN(S) which you w削u§e fo富BPCL.