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Application by a person for a certificate under sections 197 and/or 206C(9) of the Income-tax Act, 1961, for no deduction/collection of tax or deduction/ collection of tax at a lower rate

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..... is likely to exceed ----------------------- (ii) without deduction of income-tax as this application is made for the person/entity specified in rule 28AB. The details are specified in Annexure-II. and/or I, ------------------------------------------------ of ------------------------------------------------ do, hereby request that a certificate may be issued to the Seller/Lessor/Licensor, authorising him to collect income-tax at lower rate at the time of debit of such amount to my account or receipt thereof from me, as the case may be. The details are specified in Annexure-III. 2. The particulars of my income and other relevant details are as under : (i) Status (State whether individual, Hindu undivided family, firm, body of individuals, company etc.) (ii) Residential status (Whether resident / resident but not ordinarily resident / non-resident during the year which is sought) (iii) 3 [ Permanent Account Number or Aadhaar Number ] (iv) E-mail ID (v) Mobile Number .....

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..... registration/exemption certificate/approval, if any, issued by the Income-tax Authority) (xiii) Where return of income for any of the four previous years preceding to the previous year referred to in (vii) has not been filed, please upload a computation of estimated total income of the previous year for which return of income has not been filed. (xiv) Where return of income for any of the four previous years has been filed in paper form, please upload the copy of such returns. I ,----------------------------------------------------- do hereby declare that to the best of my knowledge and belief what is stated above is correct, complete and truly stated, I declare that the incomes/sum referred to in this form are not includible in the total income of any other person under sections 60 to 64 of the Act. I further declare that what is stated in this application is correct. I also declare that I am making application in my capacity as ---------------------------------------- and I am also competent to make this application and verify it. I am holding Permanent Account Number .....

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..... of the Seller/Lessor/Licensor Sub-section under which tax at source is to be collected [Please specify as per table given below the subsection (s)] Estimated amount to be debited/paid Requested rate of collection (1) (2) (3) (4) (5) Date: ------------------------- Place: ------------------------ ------------------------------------ Signature ------------------------------------ ------------------------------------ Address. ] ************ Notes: 1. Substituted vide Notification no. 46/2014 dated 24-09-2014 Old form Application by a person for a certificate under section 197 and / or 206C(9) of the Income-tax Act, 1961, for an *deduction / collection of tax *deduction / collection of tax at a lower rate 2 . Substitu .....

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..... tion (1) of section 206C] / lessee or licensee of [specify the nature of contract or licence or lease referred to in the Table in sub-section (1C) of section 206C] (Strike out whichever is not applicable) authorizing him to collect income-tax at the rate of per cent at the time of debit of such amount to my account or receipt thereof from me, as the case may be. The particulars of my income and other details are as per para 2. 2. The particulars of my income and other details are as under : (i) Status (State whether individual, Hindu undivided family, firm, body of individuals, Company, etc.) (ii) Residential status (Whether resident / resident but not ordinarily resident / non-resident) (iii) 1 [ Permanent Account Number or Aadhaar Number ] (PAN) (iv) Tax Deduction and Collection Account No. (TAN) (v) Details of returns/statements which have become due but have not been filed : Section under which return/statement has become due Assessment year/ quarter Due date for filing Reason for not filing (1) (2) .....

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..... of assessee whose income include income under the head Profits and gains of business or profession : (enclose copies of profit and loss account and balance sheet along with audit report, if audited, for the last three previous years) Previous year Gross sales, turnover receipt of business or profession Gross profit Net profit In rupees In percentage to amount stated in column (1) In rupees In percentage to amount stated in column (1) (1) (2) (3) (4) (5) (6) (ix) Details of existing liability under Income-tax Act, 1961 and Wealth-tax Act, 1957: Assessmen .....

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..... s of which are given in the Schedules above, stand in my name and are beneficially owned by me, and the income therefrom is not includible in the total income of any other person under sections 60 to 64 of the Income-tax Act, 1961. I further declare that what is stated in this application is correct. Date________________ _____________________ Signature Place________________ _____________________ Address Strike out whichever is not applicable. ANNEXURE I [For the purpose of tax deduction at source] Please furnish the particulars with the Schedules below in respect of the payments for which the certificate is sought. SCHEDULE I Description of securities .....

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..... Income from sources other than salary and income from house property Estimated total income (1) (2) (3) (4) (5) (6) (7) SCHEDULE VI Sl.No. Name and address of person responsible for paying rent Estimated amount of rent to be received (1) (2) (3) SCHEDULE VII Sl.No Name and address of the mutual fund No. of units Classes of units and face value of each unit Total face value of units Distinctive numbers of units Estimated amount of income to be received (1) (2) (3) (4) (5) .....

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..... address of person responsible for paying compensation or enhanced compensation or the consideration or enhanced consideration on account of compulsory acquisition of immovable property Estimated amount of compensation or the enhanced compensation or consideration or the enhanced consideration (1) (2) (3) Date ________________ _________________ (Signature) Place___________________ _________________ (Address) ANNEXURE I-A [For the purpose of tax deduction at source] Please furnish the particulars in the Schedule below in respect of the payments for which the certificate is sought, - SCHEDULE Sl. No. Nature of payment Estimated amount of incomes/sum to be received (1) (2) (3) .....

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