INCOME-TAX RULES, 1962

FORM NO. I5G

[See sectlon 197A(1), 197A(1A) and rule 29C]
Declaration under sectlon 197A(1) and sectlon 197A(1A) to be made by an
Indivldual or a person (not being a company or firm) clalmlng
Ing certaln
Incomes wlthout deductton of tux
PARTI
1. Nane of Asesnce (Declarana) Fatup KUMAR PRAD 2. PAN d the Asesee T1Pp3OrA L
3.Stotus
NDIVISOAL
4 Previous
9023-244
drsbih lolaratlon is te ntale)
5. Residential Stus

6.Flat/or/Bloxk Ne. 7 Nameof Pre:nists 9, Ara. LaNaley

Jerkoa
10 Towy CIy Drit 11.State Hest Benga12. PIN 412401.
14 Telenhe (with sTD I5 (ui Whether asesd ta tax under the
Codel ud Mobile Na Incom-tan Act, 161:
|4434444432 (h LF ves, latest asyument year tor wltich asessed
I6. Eatimated incone for which this declaration 17, Estimated tutal inicoe l the PY nwhkh
inome Tenoncd in culln l lo neODA
I3. Detuils f Fam No. I5G other than tis torn led during the pivs yea, if any
Tocal Nu.uf Fomu Nu, 15G iled Aguregate arnoant ot came fu swtich Fotn Nool5G liet
NP NA
19. Details uf iincue lorwhich the declariton is Filed
Naturef incote Stction udet whels tis Anount o incume
kentitication nunher ofrelevant
inestment/accoa, etc. is deuctible

PF|o1064 q2304 PF HITHDRAMAL 192A

Signauire of the Declaran
Declaration/Verification'
"UWe.ANyp KuMA.QRADMAN. do hereby declare that to thestated,
best of'1/Wedeclarethat
"my our knot
cdgeand belicf what isstatedaboveiscorrect,complete and istrulv
the incomes referred to in this form are not includible in the total income of any otherperson
under scetions 60 to 64 of the Income-tax At, 1961l. "T/We urnher delare that the tax 'on
l6 and
my/our estimated total icome including income/incones relerred to in column
aggregate amount ol "income/incomes relered to in colun vear 18 co1puted in accordattce
withtheprovisions of the Income-taxAet, 1961,fortheprevious endingon.20.4
relevant to the assess1ment year.225..2.4.... will be mil. T/We also declare that 'mvour
"income/incomes referred to in column l6'and the aggregate anmount of icome/ihcomes
referred to in column 18 lor the previous ycar endimg ou 32.4. relevant to the
asscssmcnt vear.202.3..2... will not exceed the maximum amount which is not charge
able to income-tax.

Place: ERAMnBn4.
Signatt1re of the Declarant"
Date: .....

Farlier Form No. 15G w

2015,
1. Substituted bv IT (Fourteenth Aridt.) K u S l1-10-2015.
ew.cf. 8 aud later on anended by the
inserted by the lT (Fifth Amdt) Res e Eurteenth Amdt) Rules, T9,
IT (Filh Amdt.) Rules, S , 2-6-2002 and substituled by the
20)-11-1990 and n awen A n u S d Adt.) Rules, 2013, W..193.
Eighth Amdt.) Rules. 2003, w.ef.9