ACHe=) 1633 (Seo. Declaration under section 197A(16) or more claimin, yao FORM NO, 15H ‘Section 197A(1C) and rule 290] ) to be made by an individual who is of the age of sixty years cortain incomes without deduction of tax. 8. ArealLocality : PARTI 1 ed ae) 2.PAN ofthe Assesses’ | 3, Date of Birth’ Ralsndva 7 or graha, PEPE 334 TK roe aS Giri s ematy sonbep npe a =f ‘Name of Premises. ae BRACE, Keller titre : ask a 9, TownlCity/District Kabsna 2hne 7 Reaffieeitn man 1. PIN mahens fen 121306 18. Telephone No. (with STD. Code) and Mobile No. FA BGAN Sh, 12, Email 14 (@) Whether assessed to tax': Yes (b) Ifyes, latest assessment year for which assessed | 14 (@) Whether assessed totax': Yes] No Ll | ‘Total No. of Form No.15H filed 16. Estimated income for which this declaration is made 16. Estimated total income of the P-Y. in which. ‘income mentioned in column 15 to be included* COC 17, Details of Form No.16H other than this form filed for the previous year, if any’ —— Aggregate amount of income for which Form No.15H filed 18. Details of income for which tho declaration is filed Sl. | Identification number of relevant ‘Nature of income Section under which | Amount of income No. | investment/account, ete.’ taxis deductible | ]__joT=.5020/99 61T0 94964 & |p.-v-¢: $0 20/997/To92 751 4 INT. 6; $0%0/42H9T5q24s-| 1 TD ACNo-24/T24, [A [os em> F)60/ Sis/2- Go |Fp ne-S16¢/Eys/ fF WSDeD \7__Ip.wp-Pe-Ddy BI-FB ‘Signature of the Declarant Scanned with CamScannerDeclaration/Verification’ “J wwe Gohereby declare that I am resident in India within the meaning of section Gof the Income-tax Act, 1961. also hereby declare that to the best of my knowledge and belief what is stated above is correct, complete and is truly stated and ‘that the incomes referred to in this form are not ‘includible in the total income of any other person under sections 60 to 64 of the Income-tax Act, 1961. I further declare that the tax on my estimated total income including *incorefincomes referred to in column 16 *and aggregate amount of “income/incomes referred to in column 17 computed in accordance with the provisions ofthe Income-tax Act, 1961, for the proviousyearendingon relevantto the assessment yéar 2.020, ~ 2 22.),. willbe. rue: Ka Sata » § Signature of the Declarant ‘ PART II 7 {To be filled by the person responsible for paying the income referred to in column 16 of Part I] 1, Name of the person responsible for paying 2, Unique Identification No . 8, PAN of tho person rosponsible for paying ri Pes4 347K 4. Complete Address, Sande PM PAYmey | | 5 TAN of the person A. [25 wraky) S cpaka responsible for paying en Ch Sac Cat © 7, Telephone No, (wth $70 Coto and Mobile No,| AAS TECZIS 6. Email ‘8, Amount of income paid” 9, Date on which Declaration is received (DD/MM/YYYY)] 10. Date on which tho income has been paid/eredited (DDIMMIYYYY) we Keltnn AR Preset Signature of tho person responsible for paying the income referred to irt column 16 of Part I ‘Delete whichever is not applicable, clon 20¢AAG the dcartion under sen 197A shalb lava dart ato furiahvaléPemaneat i‘ * Declaration ean be furnished by a resident individual whoisof the age of 60 years or more nt any time during the previousyeer. “The financial year to which theincome pertains. “Plooe mention "Yd" if esesed tax under tho provisions of Tnem-ax At 1981 fr ny of th aaeeement yer ot fsx eseemmentyera pritog hngearinwaich tbe session sed Pane onto the smnunt estimated eal come of he prevos yar for which the delratin is led inchudig tho aunt fine for eee Form No. 1SHis filed bofo filing this declaration during the previc ition tho total number of such Fa aaa nare pte Perm Na 15a fed fre ng ts daraton drag tha prvi your men lento ala umbraf eh Pers esa anya ae Neanvantctinee i wishes dlarstenbene tee ed ‘Ntesin the dns maa fhe, esont ber fra dps eervng pes Nanal Baring eames ti isan pl punberemlonmcsieee a Bete rae hs deioPereatin the declarant should sik tha he formation fried thio rm xt ad “Bees sein the decree hing fe snement inte Gotrantaloehals ee orcad Setiticndonemianbepeiate an ina ease where tax oughta bo evaded execs trent lh ropes with grou ingrsomont which shal ot be than st : months but which may extend toseven years and with fine; *prioe (a inanyothercase,wthrigorousimrionnent whic calletelesthaa tre oathrbut wich may extend otwoyeare and ihe. "The person: ssible for paying the income referred to in column 16 of Part I shall allot a unique identification number to ail the Form No. 16H_ raed byhie luringaquarter fhe nancial yer and rh fea punter dg wi areas prema TAA the Income-tax Rules, 1962 in the TDS statement furnished for the same r. In case the person has also received Form No.15G during the ‘Shogun pstinoprtnreirlustr Forma al fom ed a The person responsible for paying the income referred tin column shall not accept the declaration where the amaunt fncom aa eae al er anes yet in which sush income| tobe included exceeds the maximum amount whichis uot chargeable to ax after alowing ded peeroee : : tn eh Such inca lose fang ander the head "acore fem house property for which the delarantisebpbe- Pr deciding ges Chapter VA Tayo tthe ogee aot enw, as te away be eporad ytd b and ‘PRINT, 177, Pern Nariman Bazargate) Steet, Fort, Mumbal- 400001 « Ph: 4347 0809 » 2269 8521 Scanned with CamScanner