Declaration under section 197A(1) and section 197A(1A) of the Income-tax Act, 1961 to be made by an individual or a person (not being a company or firm claiming certain receipts without deduction of tax

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.....e.f. 01-09-2019 ============= Document 1 INCOME-TAX RULES, 1962 3 "FORM NO. 15G [See section 197A(1). 197A(1A) and rule 29C] Declaration under section 197A (1) and section 197A(1A) to be made by an individual or a person (not being a company or firm) claiming certain incomes without deduction of tax. 1. Name of Assessee (Declarant) PARTI 2. PAN of the Assessee' 3. Status 4. Previous year(P.Y.) 5. Residential Status (for which declaration is being made) 6. Flat/Door/Block No. 7. Name of Premises 8. Road/Street/Lane 9. Area/Locality 10. Town/City/District 11. State 12. PIN 13. Email 14. Telephone No. (with STD Code) and Mobile No. 15 (a) Whether assessed to tax under the Income-tax Act, 1961³: Yes No (b) If yes....

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...................... relevant to the assessment year .......... will not exceed the maximum amount which is not chargeable to income-tax. Place: Date: PART II Signature of the Declarant [To be filled by the person responsible for paying the income referred to in column 16 of Part 1| 1. Name of the person responsible for paying 3. PAN of the person 4. Complete Address responsible for paying 6. Email 9. Date on which (DD/MM/YYYY) 2. Unique Identification No." 5. TAN of the person responsible for paying 7. Telephone No. (with STD Code) and Mobile No. 8. Amount of income paid Declaration is received 10. Date on which the income has been paid/credited (DD/MM/YYYY) Place: Date: *Delete whichever is not applicable. Signature of ....

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....tion, the declarant should satisfy himself that the information furnished in this form is true, correct and complete in all respects. Any person making a false statement in the declaration shall be liable to prosecution under section 277 of the Income-tax Act, 1961 and on conviction be punishable- (i) in a case where tax sought to be evaded exceeds twenty-five lakh rupees. with rigorous imprisonment which shall not be less than six months but which may extend to seven years and with fine; (ii) in any other case, with rigorous imprisonment which shall not be less than three months but which may extend to two years and with fine. "The person responsible for paying the income referred to in column 16 of Part I shall allot a unique ident....