INCOME-TAX RULES, 1962 "FORM NO. 15G {See section 1974(1), 197ACIA) and rule 29C] Declaration under «I section 197A(IA) to be made by an Individual or a person (not being a company or firm) claiming Incomes without deduction of tx PAR [hare stance Oa Dosa ddd [ ARRRTISE cman By 0095 | LPUOGZTK 5. Residential Stgtust Qo sihowl ___ 6, Flat/Door pats BF] FName ol premseyc can) dla Fame na 24 tilda, fo Tey Ga Dist LTS ri) wade [OB FIN. bay go. Leiba Ee each chen Ta. Telepfiine No. (ith STD 15 (a) Whether assessed fo tax under the Yes No Code) andl Mobile No. Income-tax Aet, 1961 J qoo3e4IsTt) (2) If yes, latest assessment year for which assessed 16, Estimated income for which this declaration 17. Estimated total income of the PLY. in which ismade - income mentioned in columa 16 to be included? 18, Details of Form No. 15G other than this form filed during the previous year, ifany? “Total No.of Form No, 156 filed ‘Aggregate amount of income for which Form No.15G filed nll wy 19, Details of income for which the declaration is filed Sl._| Identification number of relevant [Nature of income | Section under which tax | Amount of income No. | investment/account,ete* isdeductible | VaNNOVE2 2533302 | Oe athdnanl| gection 192% tidak nal Signature of the Declarant® eclaration/ Verification”? “"V/We...2: lol aks . do hereby declare that to the best of ‘my/our knowl- edge and belief whatis stated aboveis correct, complete and is truly stated. "I/We declare that the incomes referred to in this form are not includible in the total income of any other person under sections 60 to 64 of the Income-tax Act, 1961. “I/We further declare that the tax *on my/our estimated total income including "income/incomes referred to in column 16 ‘and aggregate amount of “income/incomes referred to in column 18 computed with the provisions of the Income-tax Act, 1961, for the previous year ending on relevant to the assessment year 202 will be nil “I/We also declare that ‘my/our *income/incomes referred to in column 16 “and the aggregate amount of “income/incomes referred to in column 18 for the previous year ending on 2. assessment year .S62h.2.26%8 able to income-tax. relevant to the will not exceed the maximum amount which is not charge- aNd Signature of the Dedlarant Substituted by IT Fourteenth Amdt.) Rules 201 1-10-2015, Earlier Form No. 15G was inserted by the IT (Fifth Amdt.) Rules, 1982, w.c.. 21-6-1982 and later on amended by the IT (Fifth Amdt.) Rules, 1989, ware. 1-4-1988, IT (Fourteenth Amdt.) Rules, 1990, wel, 20-11-1990 and IT (Twelfth Amdt.) Rules, 2002, w.ef. 21-6-2002 and substituted by the IT (Eighth Amdt.) Rules, 2003, w.c.f. 9-6-2003 and IT (Second Amdt.) Rules, 2013, wae, 19-2-2013.PARTI [To be filled by the person responsible for paying the Income - referred to in column 16 of Part H ame of the person responsible tor payin dA Kdemtification No!" 3. PANof the person | a Complete Adilrwes BOTAN of the person responsible for paying responsible for paying 6. Baal 7.Velephone No, (with STD Cauley and Mobile Ni 9. Date on which Declaratic (D/MAVYYYY) 8. Amount of income paid is received 10. Date on which the income has heen paid/credited (ob/MM/VYYY) Signature of the person responsible for pay’ the income referred to in column 16 of Part I “Delete whichever is not applicable. ‘Asper provisions of section 206AA(2), the declaration under section 197A(1) or 197A(1A) shall be invalid if the declarant fails to furnish his valid Permanent Account Number (PAN). *Declaration can be furnished by an individual under section 197A(1)and person (other than a company or a firm) under section 197A(IA). ‘The financial year to which the income pertains. “Please mention the residential status as per the provisions of section 6 of the Income-tax Act, 1961, “Please mention “Yes" if assessed to tax under the provisions of Income-tax Act, 1961 for any of the assessment year out of six assessment years preceding the year in which the declaration is filed. “Please mention the amount of estimated total income of the previous year for which the declaration is filed including the amount of income for which this declaration is made. “In case any declaration(s) in Form No. 15G is filed before filing this declaration during the previous year, mention the total number of such Form No. 15G fil amount of income for which said declaration(s) have been filed. “Mention the distinctive number of shares, account number of term deposit, recurring deposit, National Savings Schemes, life insurance policy number, employee code, ete. “Indicate the capacity in which the declaration is furnished on behalf of a HUF, AOP, etc. ‘Before signing the declaration/verification, the declarant should satisfy himself that the information furnished in this form is true, correct and complete in all respects. Any person making a false statement in the declaration shall be liable to prosecution under section of the Income-tax Act, 1961 and on conviction be punishable- (ina case where tax sought to be evaded exceeds twenty-five lakh rupees, with rigorous imprisonment which shall not be less than six months but which may extend to seven. years and with fine; led along with the aggregate (i _inany other case, with rigorousimprisonment which shall not be less than three months but which may extend to two years and with fine, ''The person responsible for paying the income referred to in column 16 of Part I shall allo 4 unique identification number to all the Form No. 15G received by him during a quater o the financial year and report this reference number along with the particulars prescribed inrule 3TA(@)(vi of the Ineome-tax Rules, 1962 the TDS statement furnished for the quarter, Incase the person has also received Forny No. FSEL during the same qi allot separate series of serial mumber for Form No.15G and Form No.1SH. The person responsible for paying the income referred to in column 160f Part F shall not accept the declaration where the amount of income of the nature rel (1) oF sub-section (1A) of section 197A or the aggregate of the credited ov paid or likely to be credited or paid during the previous year in which such income is to be included exceeds the maximum amount which is not chargeable to tax. For deciding the eligibility, he is required to verify income or the aggregate amount of incomes, as the & may be, reported by the declarant in columns 16 and 18. me ter, please red to in sub-section ints of such income