Yornne INCOME-TAX RULES, 1962 FORM NO. 15G [See section 197A(1), 197A(1A) and rule 29C] Declaration under section 197A(1) and section 197A(1A) to be made by an individual or a person (not being a company or firm) claiming certain incomes without deduction of tax PARTI T Namco! Anca (Declarant) MORTED SHMAA | 2 PaNultheAwewee’ DT FPS YTep 3 Status? 4. Previous year(P.Y)) 3020 -dwLt 5. Residential Statyis* EstayipuP Gor which Gestiva i bates nats) Coweweo) [oesoew F 6 Pat Dowr/Bhxh No, | TNamoul Promineyg | _& Rond/Sirt/Lane 9. Area/ Locality VSM 0 Town/City/District Ti State HARYANA [Link] 135002 13. Email 3 ‘ 15 (@ Whether awesed to tax under the Yes Codie) and Mobile No Income-tax Act, 1961 ao 49) 99962 UASHY (HI yes, latest assessment year for which assessed 16 Estimated ncorg or whthisdevlraton V7 Esinatd wil income TSP BHC aeobo ismade Chooe income mentioned in column 16 wo be included 18. Details of Form No. 15G other than this form filed during the previous year if any” — Total No, of Form No, 15G filed ‘Aggregate amount of income for which Form No13G filed 19, Details of income for which the declaration is filed SL] entification numberof relevant | Natureof income “Amount of income No, | investment/accountctc?* is deductible falancd =e een Signature of the Declarant’ Declaration/ Verification” “1/[Link] suaena do hereby declare that to the best of “my/our knowl- edgeand belief what isstated aboveis correct, complete and istruly stated. I/We declare that the incomes referred to in this form arc 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 in accordance with the provisions of the Income-tax Act, 1961, for the previous year ending on...d8ke..2edch relevant to the assessment year 2:2! will be nil. ‘I/We also declare that “my/our “income/incomes referred to in column 16 “and the ageregaje,gmpoint of “income/incomes referred to in column 18 for the previous year ending pre relevant to the will not exceed the maximum amount which is not charge- MEN EAP neh able to income-tax. Signature of the Declarant’ 1, Substituted by IT (Fourteenth Amdt.) Rules 2015, w. inserted by the IT (Fifth Amdt) Rules, 1982, wa IT (Fifth Amdt) Rules, 1989, wares. 1-4-1988, 20-11-1990 and IT (Twelfth Amdt.) Rules, 2002, w. (Eighth Amdt.) Rules, 2003, [Link]. 9-6-2003 and IT (Se 1-10-2015, Earlier Form No. 1SG was 6-1982 and later on amended by the (Fourteenth Amdt) Rules, 1990, wef, [, 21-6-2002 and substituted by the IT nd Amdt.) Rules, 2013, wef, 19-2-2013. MaoPART It [To be filled by the person responsible for paying the income referred to in column 16 of Part I] 2. Unique Identification No." 3. TAN of the person responsible for pay 3. PAN of the person responsible for paying 6. Email 7. Telephone No. (with STD Gode) and Mobile No. [ 8. Amount of income paid’ | 9, Date on which Declaration is received 10, Date on which the income has been paid/credited (DD/MM/YYYY) (DD/MM/YYYY) Placé ‘Signature of the person responsible for paying the income referred to in column 16 of Part I Date? on “Delete whichever is not applicabl \Asper provisions of section 206AAQ), the declaration under section 197A(1) or 197A(1A) shall be invalid if the declarant fails to furnish his valid Permanent Account Number (PAN). 2Declaration can be furnished by an individual under section 197A(1) anda person (other than a. company or a firm) under section 197A(1A). “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. sPlease 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 filed along with the aggregate 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, etc. “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 277 of the Income-tax Act, 1961 and on conviction be punishable- (0 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; (i) inany othercase, with rigorous imprisonment 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 allot a unique identification number to all the Form No. 15G received by him during a quarter of the financial year and report this reference number along with the particulars prescribed inrule 31A(4)(vii) of the Income-tax Rules, 1962 in the TDS statement furnished for the same quarter. In case the person has also received Form No.15H during the same quarter, please allot separate series of serial number for Form No.15G and Form No.15H. "The person responsible for paying the income referred to in column 16 of Part I shall not accept the declaration where the amount of income of the nature referred to in sub-section (1) or sub-section (1A) of section 197A or the aggregate of the amounts of such income credited or 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 case may be, reported by the declarant in columns 16 and 18.