Specified fund concessional taxation statement requires detailed attribution of income to non-resident unit holders and supporting declarations. Statement of income in prescribed form for a specified fund claiming concessional taxation on income attributable to non-resident unit holders under section 210(2). The form requires identification particulars of the fund, the tax year, and total income, then separately reports income from securities and capital gains attributable to non-resident unit holders through assets under management ratios. A declaration confirms satisfaction of the relevant conditions and the correctness and completeness of the statement and annexures.