Form of declaration under section 203 of the Finance Act, 2016 in respect of the Direct Tax Dispute Resolution Scheme, 2016

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..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   E-mail . . . . . . . . . . . . . . . . . . . . Telephone No. . . . . . . . . . . . . . . . . . . .   Residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   E-mail . . . . . . . . . . . . . . . . . . . . Telephone No. . . . . . . . . . . . . . . . . . . . . 3. Permanent account number (PAN) . . . . . . . . . . . . . . . . . . 4. Status of the declarant   (a) State w....

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.... . . . . . . . . . . . . . . . . . . . . . . . . . . .     (ii) Interest up to the date of assessment . . . . . . . . . . . . . . . . . . . . . . . . . . .     (iii) Total . . . . . . . . . . . . . . . . . . . . . . . . . . .   (e) Demand outstanding out of (d)(iii) above as on the date of making declaration under section 202 . . . . . . . . . . . . . . . . . . . . . . . . . . .   (f) Amount payable under section 202(I)(a) : . . . . . . . . . . . . . . . . . . . . . . . . . . .     (i) Amount as per (e) above . . . . . . . . . . . . . . . . . . . . . . . . . . .     (ii) 25% of minimum penalty leviable if (d)(i) is of Rs.10 lakh or more . . . . . . . . . . ....

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.... . . . . . . . . 2. Date of assessment order and section under which assessed . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Assessment year . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Amount payable as per the assessment order/any other order       (i) Tax . . . . . . . . . . . . . . . . . . . . . . . . . . .     (ii) Interest . . . . . . . . . . . . . . . . . . . . . . . . . . .     (iii) Total . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Amount paid out of 4(iii) above . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. Demand outstanding as on the date of making declaration under section 202 . . . . . . . . . . . . . . . . . . . ....