FORM NO. 1 - Statement of Specified Services or E-Commerce Supply or Services - Equalisation levy Rules, 2016

1 [ FORM NO. 1 [See rule 5 of Equalisation levy Rules, 2016] Statement of Specified Services or E-Commerce Supply or Services EL-1 ACKNOWLEDGEMENT For Office use only Receipt No. .. Date Please follow instructions. Use block letters only. I. Please tick ( ) from the following which is applicable: Assessee E-Commerce Operator II. (i) Statement filed under: Section 167(1)/ 167(2) (Belated/ Revised)/ 167(3) (ii) Document Identification Number, if filed u/s 167(3): . 1. NAME 2. ADDRESS 3. PERMANENT ACCOUNT NUMBER/ AADHAAR 4. FINANCIAL YEAR 5. WARD/ CIRCLE/ RANGE (IN RS.) 6. TOTAL AMOUNT OF CONSIDERATION (i) FOR SPECIFIED SERVICES PAID/ CREDITED (IN CASE OF ASSESSEE) (ii) RECEIVED OR RECEIVABLE FROM E-COMMERCE SUPPLY OR SERVICES (IN CASE OF E-COMMERCE OPERATOR) 7. EQUALISATION LEVY ON ITEM 6 8. TOTAL EQUALISATION LEVY DEDUCTED (Not applicable in case of e-commerce operator) 9. TOTAL EQUALISATION LEVY PAID 10. EQUALISATION LEVY PAYABLE/ REFUNDABLE (7-9) 11. INTEREST PAYABLE LADER SECTION 170 12. INTEREST PAID PART-B (For Assessee) DETAILS OF EQUALISATION LEVY DEDUCTED PAID TO THE CREDIT OF THE CENTRAL GOVERNMENT Sl. No. Name of the non-resident providing specified service Address of the non-resident referred to in column 2 PAN if, available of non-resident referred to column 2 AADHAAR, if available Amount consideration for specified services paid/ credited Date of payment / credit of amount of consideration for specified services Equalisation levy Interest Penalty BSR Code Challan Sl. No. Date on which amount deposited (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) PART-B (For E-commerce Operator) DETAILS OF EQUALISATION LEVY PAID TO THE CREDIT OF THE CENTRAL GOVERNMENT Sl. No. Quarter of the Financial Year* Amount of consideration paid/ credited Equalisation Levy Interest Penalty Penalty BSR Code Challan Sl. No. Date on which amount deposited (1) (2) (3) (4) (5) (6) (7) (8) (9) *Q1, Q2, Q3 and Q4 to be used for Quarter ending June, September, October and March respectively. VERIFICATION I, __________________ (full name in block letters), son*/ daughter of _______________ having permanent account number ________________ solemnly declare that to the best of my knowledge and belief the information given in this statement is correct and complete and in accordance with provisions of Chapter VIII of the Finance Act, 2016 and Equalisation levy Rules, 2016. I further declare that I am making this statement in my capacity as ____________ and I am competent to make this statement and verify it. Date ________ Place ____________ (Name and Signature) Notes: 1. *Delete whichever is not applicable. 2. Assessee means a resident and carrying on business or profession or a non-resident having a permanent establishment in India, who is required to deduct the equalisation levy from the amount paid or payable to a non-resident in respect of specified service (section 166 of the Chapter VIII of the Finance Act, 2016) 3. E-commerce operator means a non-resident who owns, operates or manages digital or electronic facility or platform for online sale of goods or online provision of services or both, and is required to pay equalisation levy under section 166A of the Chapter VIII of the Finance Act, 2016. 4. This Form is to be furnished and verified by- (i) in case of an Individual or HUF, the person authorised to verify, the return of income under section 140 of the Income-tax Act, 1961; (ii) in case of company, the person authorised to verify the return of income under section 140 of the Income-tax Act, 1961 or the Principal Officer; (iii) in any other case; the Principal Officer. ] *************** NOTES:- 1. Substituted vide Notification No. 87/2020 dated 28-10-2020 before it was read as, APPENDIX FORM NO. 1 [See rule 4 of Equalisation levy Rules, 2016] STATEMENT OF SPECIFIED SERVICES EL-1 ACKNOWLEDGEMENT For Office use only Receipt No. Date .. .. Seal and Signature of Receiving Official Please follow instructions. Use block letters only. PART-A 1. NAME OF THE ASSESSEE 2. ADDRESS OF THE ASSESSEE 3. PERMANENT ACCOUNT NUMBER (PAN) 4. FINANCIAL YEAR (SPECIFIED SERVICE RELATING TO WHICH ARE REPORTED) - - 5. WARD/CIRCLE/RANGE (IN RS.) 6. TOTAL AMOUNT OF CONSIDERATION FOR SPECIFIED SERVICES PAID/CREDITED 7. EQUALISATION LEVY DEDUCTIBLE ON ITEM 6 8. TOTAL EQUALISATION LEVY DEDUCTED 9. TOTAL EQUALISAVION LEVY PAID 10. EQUALISATION LEVY PAYABLE/ REFUNDABLE (7-9) 11. INTEREST PAYABLE UNDER SECTION 167 12. INTEREST PAID PART-B DETAILS OF EQUALISATION LEVY DEDUCTED PAID TO THE CREDIT OF THE CENTRAL GOVERNMENT Sl. No. Name of the non-resident providing specified service Address of the non-resident referred to in column 2 PAN if, available of non-resident referred to column 2 Amount consideration for specified services paid/ credited Date of payment / credit of amount of consideration for specified services Equalisation levy Interest Penalty BSR Code Challan Sl. No. Date on which amount deposited (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) VERIFICATION I, __________________ (full name in block letters), son*/ daughter of __________________ having permanent account number _________________ solemnly declare that to the best of my knowledge and belief the information given in this statement is correct and complete and in accordance with provisions of Chapter VIII of the Finance Act, 2016 and Equalisation Levy Rules, 2016. I further declare that I am making this statement in my capacity as ____________________ and I am competent to make this statement and verify it. Date ____________ Place ____________ (Name and Signature) Notes: 1. Delete whichever is not applicable. 2. Assessee means a resident and carrying on business or profession or a non-resident having a permanent establishment in India, who is required to deduct the equalisation levy from the amount paid or payable to a non-resident in respect of specified service (section 166 of the Chapter VIII of the Finance Act, 2016). 3. This Form is to be furnished and verified by- (i) In case of an Individual or HUF, the person authorised to verify the return of income under section 140 of the Income-tax Act, 1961; (ii) In case of company, Managing Director or Director or principal Officer; (iii) In any other case, Principal Officer.