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FORM NO 15G [See section 1974(1),197A(1A) and rule29C] Di Declaration under section 197A(1) and section 197A(1A) to be made by an individual or a persion (not being Pany or firm) claiming certain incomes without deduction of tax. PART I F Cust.ID: 5708193 _ Name of Assessee (Declarant) B:PAN of the Agsessee | MRYUVARAIL ——foorvasson eens) revious Year Fee ee | P For which declartion is being made] _[®-Residential Status ca NoNTDUAL———————"poza-noeg Iron eee {6 Flat/Door/Block No. [Name of Premises _[6-RoadiStreetiLane SIO LOGANATHAN 25 S M IIVAPPAN NAGAR WEST DASS AVENUE JKANCHIPURAM. }0.Town/City/District fi.State [12.Pin Code. IKANCHIPURAM_ FAMILNADU, 631507 —_ uvarajioganathan28@gmail.com [15.(a) Whether assessed to tax under the lincome -tax Act. 1961: ClYeS (INO \b) if yes, latest assessment year for which assessed 4.Telephone No (With STD |Code) and Mobile No. j9500792500 3 7 — Aan ~ 7 Estimated total income of the P.Y. in which income ___|16. Estimated income for which this dectartion fs made [renioned in column 16 0 be ncuded 2348.00 '8,Details of Form No. 15G other than this ed during the previous yoat any? “aggregate Amount of Income for which Forms Wo __iiled INature of Income Amount of Income Interest faa fraza.oo 4 froszooososoot77____nterest__ 84 6736.00 froszotesorores4 _interest__ : 993.00 : [0520165010256 I mini 94 193.00 | Signature of the Declarant Declaration/Verification

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