TO :   BHARAT PETROLEUM CORPORAT量ON LIMITED

DECLARA TION

I the Proprietor of M/s BG SHⅣAPRAKASH MIRJI

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.

b. Mysales/gross receipts/turnoverforthefinanciaI yea「 2020-21 atthe PAN leve書Exceeds Rs.10crores・ PIeasetickeither

′′YES〃o「〃NO’’:

(  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

TAN ifanswerto ′b’above is “NO〃)

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).

e・ I / We give the below declaration with respect to section 206AB / 206CCA‥

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

any clanse in this declaration.                                 ,

g. I hereby declare that I am duly authorized to sub血t and sign this declaration・

Yours Faithfully

For BG SHIVAPRAKASH MⅢ

NAME: BG SHIVAPRAKASH MI則Ⅱ

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.