ACKNOWLEDGEMENT OF DECLARATION UNDER SECTION 183 OF THE FINANCE ACT, 2016 IN RESPECT OF THE INCOME DECLARATION SCHEME, 2016

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............ (hereinafter referred to as the declarant) has filed a declaration under section 183 of the Finance Act, 2016; And whereas the said declaration has been received on ............................. ; Now, therefore after consideration of relevant material, I hereby determine the following amount payable by you with respect to the declaration made under the scheme: Sl. No. Assessment year....

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....e of the sum payable as reduced by the amount paid under clause (i) and (ii) above on or before 30th day of September, 2017. In case of non-payment of the amount as specified above, the declaration under Form-1 shall be treated as void and shall be deemed never to have been made.] ......................................................... Name, signature and seal of Designated Authority Place .....