FORM NO.
13C:
Application for a certificate under section 194C(4) of the nco!e"#a$ Act% 19&1% relatin' to
deduction of inco!e"ta$ fro! pa(!ents !ade to contractors and su)"contractors
[See rule
27
[28(2)]]
To
The
28
[Assessing Officer],
____________________
____________________
Sir,
I __________________________, [name] of _______________, [address] do hereby declare that my total income
(including income comrised in ayments of the nature referred to in section !"#$ of the Income%ta& Act, !"'!(
comuted in accordance )ith the ro*isions of that Act for the re*ious year rele*ant to the assessment year __ %__
)as less than the minimum liable to income%ta&+ amounted to ,s- _______________ and I ha*e no reason to e&cet
that my total income (comuted as aforesaid( for the three assessment years ne&t follo)ing )ill increase
substantially-
2- I, therefore, [Link] that a certificate may be issued to the erson(s( resonsible for aying any sum in ursuance
of the contract, articulars of )hich are gi*en in the Schedule hereto, authorising him+ them /not to deduct income%
ta&+ to deduct income%ta& at the rate of ------ er cent at the time of credit of such sum(s( to my account or, as the case
may be, ayment thereof to me-
0- I hereby declare that )hat is stated in this alication is correct-
1ate ____________
_________________________
Signature
_______________________
Address
_________________________
2ermanent Account 3umber
/Score out )hiche*er is not alicable-
*C+,-./,
*l.
No.
Full na!e and address
of the authorit(0
person 1ith 1ho! the
contract 1as !ade
-ate of
the
contract
Nature of
the
contract
-ate )( 1hich 1or2
on the contract
1ould )e co!pleted
*u!s e$pected to )e credited0 paid in
pursuance of the contract durin' the
current pre3ious (ear and each of
three i!!ediatel( succeedin' (ears
1 4 3 4 5 &
1ate _________
________________________
Signature