INCOME - TAX RULES, 1962 10002348

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.
PART I
1. Name of Assessee (Declarant) 2. PAN of the Assessee

MAYA S JOUNJAL AQUPJ8881C

3. Status 4. Previous year (P.Y.) (for which declaration is being made) 5. Residential Status

INDIVIDUAL 01-apr-2024-31-mar-2025 Resident

6. Flat/Door/Block No. 7. Name of Premises 8. Road/Street/Lane 9. Area/Locality

AT POST NIMSOD TAL KHATAV DIST SATARA

10. Town/City/District 11. State 12. PIN 13. Email

MAHARASHTRA 415538 sdccb@[Link]

14. Telephone No. (with STD Code) and Mobile No. 15 (a) Whether assessed to tax under the Income-tax Act, YES NO N

1000000000/ (b) If yes, latest assessment year for which assessed

16. Estimated income for which this declaration is made 17. Estimated total income of the P.Y. in which income mentioned in column 16 to be included

98974 240000

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 No.15G filed

0 0

19. Details of income for which the declaration is filed

Identification number of relevant investment/account, etc. Section under which tax is deductible
[Link]. Nature of income Amount of income

1 11005560005853 [Link] Deposit Section - 194A 10607.00

2 11005560005854 [Link] Deposit Section - 194A 27621.00

3 12255560003444 [Link] Deposit Section - 194A 27691.00

4 12255560003445 [Link] Deposit Section - 194A 33055.00

Signature of the Declarant

 PART I

Declaration/Verification

*I/We MAYA S JOUNJAL do hereby declare that to the best of *my/our knowledge and belief what is stated

above is 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 in accordance
31-mar-2025 relevant to the assessment year will be nil.
with the provisions of the Income-tax Act, 1961, for the previous year ending on .................................

*I/We also declare that *my/our * to in column 16 and the aggregate amount of *income/incomes referred to in column 18 for the previous
2024-2025
year ending relevant to the assessment year ......................... will not exceed the maximum amount which is not chargeable to income-tax.

(Also it should be justified (aligned) text as above.)

Place:

Date: 05-12-2024 Signature of the Declarant

PART II

[To be filled by the person responsible for paying the income referred to in column 16 of Part I]
1. Name of the person responsible for paying 2. Unique Identification No.

SATARA DISTRICT CENTRAL COOPERATIVE BANK G000004218202425PNET04126D

[Link] of the person responsible for paying [Link] Address 5. TAN of the person responsible for paying

AAAAT3706H Sadar Bazar,Camp,Satara 415001 PNET04126D

[Link] [Link] No. (with STD Code) and Mobile No. [Link] of income paid

[Link]@[Link] (02162) 227631 48172.00

[Link] on which Declaration is received (DD/MM/YYYY) 10. Date on which the income has been paid/credited (DD/MM/YYYY)

05-12-2024

Place:
Signature of the person responsible for paying the income referred to in column
Date: 05-12-2024
16 of Part I

*Delete whichever is not applicable.

1 As per 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).

2 Declaration can be furnished by an individual under section 197A(1) and a person (other than a company or a firm) under section 197A(1A).

3 The financial year to which the income pertains.

4 Please mention the residential status as per the provisions of section 6 of the Income-tax Act, 1961.

5 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

the year in which the declaration is filed.

6 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

declaration is made.

7 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.

8 Mention the distinctive number of shares, account number of term deposit, recurring deposit, National Savings Schemes,

life insurance policy number, employee code, etc.

9 Indicate the capacity in which the declaration is furnished on behalf of a HUF, AOP, etc.

10 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-

(i) in a 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;

(ii) in any other case, with rigorous imprisonment which shall not be less than three months but which may extend to two years and with fine.

11 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

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.

12 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.;