Statement of exempt income under Schedule VI [Table: Sl. No. 10]

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....t Number: Country Code Number     Part B: Other Details 6. Tax Year:   7. Legal status of the specified fund (refer Note 3): (select one) 8. Date of establishment/incorporation:   9. Date of commencement of operations:   10. Registration Details: (i) Registration number as per the certificate of registration is....

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....ritory as may be notified by the Central Government in this behalf: Yes/No 16. Whether the original fund and its activities are subject to applicable investor protection regulations in the country or specified territory where it is established or incorporated or is a resident: Yes/No 17. Whether the original fund fulfils conditions as may be prescribed under section 70(1)(u): ....

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....; 22. Computation of the exempt income under Schedule VI [Table: Sl. No. 10]:   (i) Income of the nature of capital gains, arising or received by the resultant fund, on account of transfer of share of a company resident in India [1]:   (ii) Aggregate value of daily 'assets under management' of the specified fund held by non-resident unit holders (not being....

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....ove are true to the best of my knowledge and belief. I also affirm that I am making this application in my capacity as ______________________ (designation) and that I am holding PAN _____________ and I am competent to make this application and verify it. It is also verified that the certification of the accountant in Form No. 179 has been filed on _____________. Place: Date: Signature:....