TaxTMI 
TaxTMI 
Statement of income paid or credited by investment fund to be furnished under section 115UB of the Income-tax Act, 1961
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....; (a) Whether registered as Category I or II : Yes/No (b) Registration number : (c) Date of registration : 8. (a) Total income of Investment Fund during the previous year ........................... (b) Break-up of total income [aggregate of amounts under column (7) of the following table for each head]: S. No. Under the head Income or Loss Loss to be set off in accordance with sub- section (2) of section 115UB Net Income or loss after set-....
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....i) above] (1) (2) (3) (4) 1. Dividends 2. Others (Please specify section if taxed at special rate) 10. Details of loss other than the loss under the head "Profits and gains of business or profession", if any, accumulated at the level of investment fund as on the 31st March, 2019: Assessment Year Amount of Loss under various Heads of Income Total Long Term Capital Loss Short Term Capital Loss (1) (2) (3) (4) 2016-2017 2017-2018 2018-2019 2019-2020 Total 11. Aggregate of loss under various heads after ignoring the loss in 9(i)(b) above [aggregate of the negative amounts in column (7) of the table under 8(b)]: ........... (i) Loss under head "Capital Gain": S. No. Category Code Amount Proportion [Column 4/ Amount at s no. 11 above] (1) (2) (3) (4) (5) 1. Long Term Capital Gain 2. Short Term Capital Gain (ii) Loss under the head "Other Sources": S. No Category Amount Proportion [Col....
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....rd of India (Alternative Investment Funds) Regulations, 2012 or the International Financial Services Centres Authority (Fund Management) Regulations, 2022. Attach audited accounts including balance sheet, annual report, if any, with certified copies of income and appropriation towards payment of income or credit of income [including amount deemed to have been credited in accordance with provisions of sub-section (6) of section 115UB]. I, ______________ (Name in full and in block letters) son/daughter/wife of__________ do hereby solemnly declare that to the best of my knowledge and belief what is stated above and in the Annexure(s), including the documents accompanying such Annexure(s), is correct and complete. I further declare that I am furnishing such statement in my capacity as __________(designation) and that I am competent to furnish this statement and verify it. Verified today the________ day of .________ Place_________________ &....
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....ain chargeable at 20% under section 111A 6 2. Short term capital gain chargeable at 15% under section 111A 7 3. Short term capital gain chargeable at 30% 8 4. Short term capital gain chargeable at applicable rate 9 * Strike out whichever is not applicable.] ____________________ Notes: 1. Inserted vide notification no. 92/2015 dated 11-12-2015 2. Substituted vide Notification No. 95/2019 dated 06-11-2019 w.e.f. 01-09-2019 before it was read as "PAN" 3. Substituted vide NOTIFICATION NO. 55/2020 dated 28-07-2020 before it was read as "FORM NO.64D [See Rule 12CB (1)(ii)] Statement of income paid or credited by investment fund to be furnished under section 115UB of the Income-tax Act, 1961 1. Name of the Investment Fund: 2. Address of the registered office: 3. Legal status: [company/trust/limited liability partnership; body corporate] 4. Permanent Account Number: 5. Previous year ending: 6. Name and address of the Directors/Trustees/Partners of the Investment fund*: S.No. Name Address (1) (2) (3) 7. (i) Whether registered as Alternative investment Fund with SEBI under Yes/No* the Securities and E....
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....e head 'Other Sources' Referred to in Section 10(38) [Column 5 x Column 4(1) of Table at s.no.9(v)] Others [Column 5 x Column 4(2) of Table at s.no. 9(v)] To which Section 111A applies [Column 5 x Column 4(3) of Table at s.no.9(v)] Others [Columns 5 x Column 4(4) of Table at s.no. 9(v)] 'Dividend '[referred to in Section 115-O] [Column 5 x Column 4(1) of Table at s.no.9(vi)] Others [Column 5 x Column 4(2) of Table at s.no. 9(vi)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) Attach a copy of the certificate of registration under Securities and Exchange Board of India (Alternative Investment Funds) Regulations, 2012. Attach audited accounts including balance sheet, annual report, if any, with certified copies of income and appropriation towards payment of income or credit of income [including amount deemed to have been credited in accordance with provisions of section....
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....tered office: 3. Legal status [company/ trust/ limited liability partnership/ body corporate: 4. Permanent Account Number: 5. Previous year ending: 6. Name and address of the Directors/ Trustees/ Partners of the Investment fund*: S. No Name Address PAN/ AADHAAR (1) (2) (3) (4) 7. (i) 4[(i) Whether registered as Alternative Investment Fund with Securities and Exchange Board of India under the Securities and Exchange Board of India (Alternative Investment Funds) Regulations, 2012 or the International Financial Services Centres Authority (Fund Management) Regulations, 2022:] Yes/No* (ii) If yes, furnish following details: (d) Whether registered as Category I/ II : Yes/No* (e) Registration number : (f) Date of registration : 8. (a) Total income of Investment Fund during the pr....
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....nbsp; (b) Income under head 'Capital Gain': S. No. Category Amount Proportion [Column 3/ Amount at 9(iii) above] (1) (2) (3) (4) 1 Long Term Capital Gain [Chargeable @10% u/s 112A] 2 Long Term Capital Gain [Chargeable @10% (other than section 112A)] 3 Long Term Capital Gain [Chargeable @20%] 4 Short Term Capital Gain [Chargeable @15% u/s 111A] 5 Short Term Capital Gain [[Chargeable @30%] 6 Short Term Capital Gain [Chargeable at applicable rate] (c) Income under the head 'Other Sources': S. No Category Amount Proportion [Column 3/Amount at 9(iii) above] (1) (2) (3) (4) 1. Dividends [referred to in Section 115- O]* 2. Others (Please specify section if taxed at special rate) *'[referred to in section 115O]' shall be omitted with effect from the assessment year 2021-2022. 10. Details of loss other than the loss under the head "Profits and gains of business or profession", if any, accumulated at the level of investment fund as on 31st March, 2019: Asse....
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.... 4(5) of Table at s.no. 9(iii)(b)] Charg -eable at appli cable rate [Column 5 x Column 4(6) of Table at s.no. 9(iii)(b)] 'Dividend' [referred to in Section 115- O]* [Column 5 x Column 4(1) of Table at s.no. 9(iii)(c)] Others [Column 5 x Column 4(2) of Table at s.no. 9 (iii)(c)] (Please specify section if taxed at special rate) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) *'[referred to in Section 115O]' shall be omitted with effect from the Assessment year 2021-2022. (ii) there is loss in respect of units held for more than 12 months as per clause (b) of sub-section (2) of section 115UB : S. No. Name of Unit Holder Address PAN/ AADHAAR Total Amount of loss paid/ credited/ Deemed to be credited Loss under the head 'Long Term Capital Gains' Loss under the head 'Short Term Capital Gains' Loss under the head 'Other Sources' [Column 5 x Column 4(1) of Table at s.no. ....