Application for issuance of certificate for lower or nil deduction of income-tax under section 395(1) and lower collection of income-tax under section 395(3)

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....l Status (refer Note 4) (f) E-mail id   (g) Contact Number Country Code Number   PART - B 2. Application filed by: (Radio Button) Registered non-profit organization Specified Entity referred to in section 263(9)(c) Person carrying on business or profession Persons other than the above   3. Details of Request I do hereby request that a certificate may be issued to: (tick as applicable) the person responsible for paying income/sum to me with deduction of income-tax at a lower rate or without deduction of income-tax. The details of these are mentioned in Annexure I. me since I do not have the details of the payer, to receive income/sum with deduction of i....

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....             2. Income-tax Act, 1961 (43 of 1961) (as it existed prior to its repeal)               5. Particulars of income and other relevant details (for the relevant tax year) (a) Estimated total income (Attach computation)   (b) Tax including interest payable on the Total income [referred to in 5(a)]   (c) Income claimed to be exempt and not included in the Total income in 5(a). (Attach note giving reason for claiming such exemption)   (d) Prepaid taxes (as per AIS): (i) Advance Tax       (ii) Tax deducted at source     ....

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.... Name:   PART - E Applicable in case of Person other than person mentioned in Part-D   Declaration I .................. having Permanent Account Number .................... do hereby declare that: the applicant has furnished the returns of income for last four tax years for which such returns became due on or before the date on which the application under sub-rule (1) of rule 213 is made. the incomes/sum referred to in this form are not includible in the total income of any other person under sections 96 to 99. Place: ............ Date: ............ Signature Name:     PART - F Verification I, _____________ (full name), having PAN _____________ in the capac....

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....sp;         ANNEXURE -III [Relevant for tax collection at source]; Please furnish following particulars in respect of amount receivable for which the certificate is sought Sl. No. Section under which tax at source is liable for collection Table Sl. No. under which tax at source is liable for collection TAN of the Seller/ Lessor/ Licensor Estimated amount to be debited/paid during the tax year Requested Rate of Collection (1) (2) (3) (4) (5) (6)                         Date...... Place..... Signature............. Notes: 1. In case of individual, the first, ....