"FORM NO. 15G [Sce section 197A(1), 197A(1A) and rule 29C] ectaration under section 197A (1) and section 197A(IA) to be made by an individual or a person (not being @ ‘company or firm) claiming certain incomes without deduction of tax. PARTI T, Name of Assessee (Declarant) Z.PAN of the Assessee! 3S le Previous yeartP-YP 202) — in (for which declaration is being made) 6. FlaUDoor/Block No. | 7. Na me of Premises 8, Road/StreevLane_ 3 __[Bolasndon,npbuldharr aotuiyarnth [Chand veda} TO, Town/Giy/Distrit_ | 11. State, 12. PIN Djareouk- Br242y Buurtamonil 4. Telephone No. (with STD TS (a) Whether assessed to tax under the ‘Yes. Code) and Mobile No. Income-tox Act, 1961: |(am))-a832-036804 (©) tyes, latest assessment year for which assessed 16. Estimated income for ich this declaration is made T7. Estimated total income of the P.Y. in which 65,000/— income mentioned in column 16 to be included® vd (40,000) — [8, Details of Form No. 15G other than this form filed during the previous year, if any” i “Total No. of Form No. 15G filed ‘Aggregate amount of income for which Form No.15G filed