lOO26l7I815
FORM NO. 15G
|Sec scction 197A(1). 197A(1A) and rule 29C]
Declaration under section 197A (1) and section individual or a person (not being
197A(1A) to be made by an
a companyor firm) claiming cortain incomos witbout deductionof tax.
PART I
1. Name of Assessee (Declarant) 2. PAN of the Assessee'
PYAPALA CHNDRA SEKARANRPPO26A
3. Status 5. ResidentialStatus4. Previous year(P.Y.'
(for which declaration is bcing made)
6. Flat/Door/Block No. 7. Name of Premises Area/Locality
|MS4 DEVI aNCLAVe LAn1 XeRE
10. Town/City/District |1. State 12. PIN 13. Email
14. Telephone No. (with STD
-ANDRA tRADESU
15(a) Whether assessed to lax under the Yes
snerareGaada,
No
Code) and Mobile No. Income-tax Act, 1961:
%444 12348 (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
18. Details of FormNo. 15G other than this form filed during the previous year, if any
Total No. of Form No. I5G filed Aggregate amount of income for which Form No.15G filed
19. Details of income for which the declaration is filed
SI Identification number of relevant Nature of income Section under which tax Amount of incomne
No. investment/account, etc. is deductible
O c o h2
e4
Signature of the
Declaration/Verification
*IWe.. .do hereby declare that to the best of *my/our knowledge and belief what is
stated above is correct, complete and is truly stated. *IWe 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 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 ..... .....relevant to the assessment year .will
be nil. *LUWe 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 relevant to the assessment
year will not exceed the maximum amount which is not chargeable to income-tax.
Place: .GBOSL
Signature of the Declarant
Date:..J2.:E 2024.
PART II
[To be filled by the person responsible for paying the income referred to in column l6 of Part I|
1.Name of the person responsible for paying 2. Unique ldentification No,
3. PAN of the person 4. Complete Address 5. TAN of the person responsible for paying
responsible for paying
6. Email 7. Teleplone No. (witlh STD Code) and Mobile No. 8, Amount of income paid'
9. Date which Declaration received 10, Date on which the incone has been pauideredited
(DD/MMIYYYY) (DD/MM/YYYY)
Place:
Signature of tlhe porson responsible for paing
Date: the inconereterred to incolumu lóof Part |
*Delete whichever is not applicable.
'As per provisions of section 206AA(2), the 197A(1A) shall be invalid if the
declaration under scction 197A(|) or
declarant fails to furnish his valid Pemanent Account Number (PAN).
Declaration can be furnished by an individual under scction than a company or a firm)
I97A(0) and a person (other
under section 197A(1A).
SThe financial year to which the income pertains.
Please mention the residentialstatus as ner the nrOvisions of section 6of the Income-tax Act, Tyo1.
Please mention "Yes" if assessed to lax under the povisions of Income-tax Act. 1961 for any of the assesstent
year out mention
Pease of six assessment yearsofpreceding
the amount cstimatedthetotal
ycarinonse
in whichofthelhedeclaration
noious vearis filed.
for which the declaration is tiled
including the amount of income for which this declaration is made.
n case any declaration(s) in Form No, 15G is filed before flino this declaration during the previous year, mention
ne total number of such Form No. 15G fled along with the ggore oate amount of income for which said
declaration(s) have been filed.
enuon the distnctive number of shares, account number of term denosit. recurring deposit, National Savings
Schemes, life insurance policy number, employee code, etc.
'Indicate the capacity in which the declaration is furnished on behalf ofa 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 Incomc-tax Act, 1961 and on conviction be punishable
imprisonment
() in a case where tax sought to be evaded exceeds twenty-five lakh rupees, with rigorous
which shall not be less than sixmonths but which may extend to seven years and withmonths
fine; but which may
three
(11) in any other case, with rigorous imprisonnent which shall not be less than
extend to two years and with fine. identification
"The person responsible for paying the income referred to in column 16 of Part Ishall allot a unique
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 Ishall 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.;
