1. Name of Assessee (Declaration) 2. PAN of the Assoeseel 3.

Dete of Birty
(DDMMYYYY
JAGANNATH SENGUPTA AKAPS4654E 4-O1-110
4. Previous year (P.YP
(or which
declaratio is being made)
3.Flat/ Door/ Block No 5lE 6. Name of Premises
2022-23|
7. Road/Street/lane
CHAT8. Area/ 9.Town/City/Diatrict 10. Stato w. B.
RA MUSALMAN PARAROAD, Locality P0-SHEORAf|HULI, HocGHLY.
11. PIN 12. Email 13. Telephone No. (with STD Code) and Mobile No.
712223
81818 7413
14. (a) Whether assessed to tax Yes No
If
6) yes, latest assessment year for which asessed

15. Estimated incomefor which this declaratioai16.Bstimated total inoome of the P.Y. in whichiincome
made Rs. 5 8 , 2 5 0 mentioned in column 15 to be inclpded
Rs. 295cgg
17. Details of Form No. 1SH other than this form filed for the previous yearaifainy
Total No of Form No. 15H filed Aggregato amount oltinoome torwacaFocm No. 5H led
NIL NIL
18. Details of income for which the declaration ia led
S ldentiñcation number of Natuire af Income Sectioa under which Amount of income
No. relevant investment/account etc." tax is deductible.
A/c. No. of FD/DDP/MIP/RD
.505i4581433 (Sess) Interest 194
A 1,29cot
2. 715122 3604 I94A 29,250E

158250
° * * * * * * * * * * o * * * * * * * * * * * * * * - . .

Signahure of the Declarant

 "CLARATION/VERIFICATION
a g oath Scngupla
JaganAlh g . .do hereby declare that Iam resident in India within the meaning ofsection
o ofthe Income-tax Act., 1961. I also hereby declare that to the best of my knowledge and belief what is
staied above is correct complete and is truly stated and tiat 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 income/ incomes referred to in column
15 and aggregate amount of *income/ incomes referredto in column 17 computed in accordance with the
provisian ofthe Incomo-tax Act. 1961. for the provious year cnding on.a. .relevant to the assessment
year will be nil.

P l a c e l cr a p h u l e
**************************** ************
Jac ma hcmgupjea
************************************4y**********
Date C 02 Signature of the Declarant

PART I
[To be filled by the person responsiblefor paying the income referred to in column 15 of Part I
1. Name ofthe person responsible for paying 2.Unique ldenification No.
Indian Bank, sheoraphuli Branch

3. PAN ofthe person responsible for 4. Complete Address 5.TANofThe Person responsible
paying 181A, G T. Road, Sheoraphuli, | for Paying
AACCA8464F CALAO6266B
Dist-Hooghly-712223(W.B.)
1"
6. E-mail 7. Telephone No. (with STD Code) and Mobile 8. Amount ofincome paid
br_aheoraphuli@allahabadbank.in (033)2632 1379
9. Date on which Declaration'is received 10. Date on which the income has been paid/credit
(DD/MM/YYYY) (DD/MM/YYYYY

Plc "'********'****'' '*''''''****'*****"'*****''*'**

Sigmature of the person responsible for paying
Dale.. income refered to in column 15 ofPart I

Delete whichever is not applicable.

I. As per provision of section 206AA (2), the declarazion under sectioa 197A(IC) shall be iavalid ifthe deciaran fails to fumish
his valid Permanent Accouat Nunber (PAN).
2 Declaration can be furnished by a reuideas individual who s oftbeo f60 year ar more at any time during the previous yecar
3. The financlal year to which the incorne pertaias.
4Pease mention "Yes"if assessed to tax under tbe provisions ofLncome-u Aa, 1961 br any ofthe assessment year out ofsix
sssesTent years precod ing the year a which the deciaracioo s led
i e r i n a tia smin nf metimatd tal incme of the orevious vear fbr whic the deciaraian is Mled inchluding the
 PANT-1
1. Name of Assessee (Declaration) 2. PAN of thbe 3. Date of Birty?
Asseesee DDMMYYYY)
SOMA SENGUPTA EJZPS 8835M 02-0/-/16l|
4. Previous year (P.Y)" (for which S.Flat/Door/ Block No LslE 6. Name of Premises
declarationis being made)2022-23
7. Road/Street/lane CHATH 8. Area / Locality
9.Town/City/District 10. State, B.
MUSALMAN PARA ROAD, P0- SHEORAPAULI, HOOGHLY
11.PIN 712223 12. Email 13. Telephone No. (with STD Code)and Mobile No.
14. (a) Whether assessod to tax": Yes
6289253664
No
(b)Lf yes, latest assessment yearfor which asessed

15. Estimated income for which this declarationi 16.Estimated total inoome of the P.Y. in which income
made s.158.cce mentioned in colmn 15 to be included
Rs.158ece
17. Details
of Form No. 1SH other than this form filed for the
previousyearH{ any
Total No of Form No. 15H filed |Aggregato amount oltnoome tor which Focm No.15H filed
NIL NIL
18. Details of income for which the declaratioo i iled
S ldentiication number of Nature of Inoome Sectioa under whichAmount of income
No. relevant investment/accountetc."| tx is dedhuctible
A/c. No. of FD/DDP/MIP/RD
.7I52956OScsS) Interest 194A
2. 7/5 2/8 62916 194A
3. 7/8222 653 194A

ToTAL I58c0c
** *********** e********.* .

Signature of the Declarant

 A ScinquPta
otaDECLARATION/VERIFICATION
*******************
...do hereby declare that l am resident in India within the meaning of section
o of the Income-tax Act., 1961. I alsohereby 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
15 and aggregate amount of
including income/ incomes referred to in colummn
income/ incomes referred to in column 17 computed in accordance with the
provisionof the Income-tax Act. 1961. for the previous year ending on.odA..relevant to the assessment
year ..t.will be nil.

lace:She craphul
Soxna S e n U ta
Date. - - 2022 ************** **°*°*************r**
Signature of the Declarant

PART I
[To be filled by the person responsible for paying the income referred to in column 15 of Part I ]

1. Name of the person responsible for 2. Unique ldenifíication No.

paying
Indian Bank, sheoraphuli Branch
3. PAN of the person responsibie for 4. Complete Address S. TAN ofThe Person responsible
paying 1814, G T. Road, Sheoraphuli, for Paying
AACCA8464F Dist-Hooghly-712223 (W.B.) CALA06266B
6. E-mail 7. Telephone No.(with STD Code) and Mobile 8. Amount of income paid "
br_sheoraphuli@allahabadbank.in (033)2632 1379
9. Date on which Declaration'is rocelved 10. Date on which the income has been paid/credit
(DD/MM /YYYY) (DD/MM/YYYYY

Plac: ******'***********'**********''°°°°*** **************s*soese************************mopsssnsnrsep.*

Signature of the person responsible for paying

Dale. *** ******** *********************"
the income referred to in column 15 of Part

Delee which.ever is not applicable.

.As perprovisionofsection 206AA (2),the declaration under section 197A(IC) ahall be luvalid ifthe declarant fals to fumish
his velid Pemanent Account Number (PAN).
2 Declaraiion can be furmished by a reuident
indi vidual who is of the ngs of 60 yaars or more at any time during the previous year.
3. The financlal year o which thé incone
pertains.
4 Please menion "Yes"ifaseased to tax under tbe provisions oflacome-tax Act, i1961 for any of the assesunent year out ofsix
&ssessment years procoding the year in which the declaration is iled