TMI BlogForm of declaration to be filed by a person who does not have either a permanent account number or General Index Register Number and who makes payment in cash in respect of transaction specified in clauses (a) to (h) of rule 114BX X X X Extracts X X X X X X X X Extracts X X X X ..... 3 Father s Name (in case of individual) First Name Middle Name Surname 4 Flat/ Room No. 5 Floor No. 6 Name of premises 7 Block Name/No. 8 Road/ Street/ Lane 9 Area/ Locality 10 Town/ City 11 District 12 State 13 Pin code 14 ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... dentification number Name and address of the authority issuing the document 25 Details of document being produced in support of address in Columns 4 to 13 (Refer note overleaf) Document code Document identification number Name and address of the authority issuing the document Verification I, _____________________, son/ daughter/ wife** of Shri ______________________, solemnly declare that to the best of my knowledge and belief, the information given in this application and documents, if any, accompanying it are correct and complete and particulars shown therein are truly stated. 2. I further declare that I /applicant does not have a Permanent Account Number and (i) my/our/applicant s estimated total income (including income of spouse, minor child etc. as per section 64 of Income-tax Act, 1961) computed in accordance with the provisions of Income-tax Act, 1961 for the financial year in which the above transaction is held will be less than maximum amount not chargeable to tax, or (ii) the applicant is a foreign company covered by the third pr ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... n 04 Yes Yes 5. Driving License 05 Yes Yes 6. Passport 06 Yes Yes 7. Pensioner Photo card 07 Yes Yes 8. National Rural Employment Guarantee Scheme (NREGS) Job card 08 Yes Yes 9. Caste or Domicile certificate bearing photo of the person 09 Yes Yes 10. Certificate of identity/address signed by a Member of Parliament or Member of Legislative Assembly or Municipal Councillor or a Gazetted Officer as per annexure A prescribed in Form 49A 10 Yes Yes 11. Certificate from employer as per annexure B prescribed in Form 49A 11 Yes Yes 12. ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ificate of registration issued by Charity Commissioner. 27 Yes Yes C. For Association of persons (other than Trusts) or Body of Individuals or Local authority or Artificial Juridical Person) Copy of Agreement or copy of certificate of registration issued by Charity commissioner or Registrar of Cooperative society or any other competent authority or any other document originating from any Central or State Government Department establishing identity and address of such person. 28 Yes Yes D. For a foreign company 1. Copy of Certificate of Registration or incorporation issued in the country where the applicant is located, duly attested by authorised officials of IFSC banking unit 29 Yes Yes 2. Copy of tax identification number issued in the country where the applica ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... Name of premises 7 Block Name/No. 8 Road/ Street/ Lane 9 Area/ Locality 10 Town/ City 11 District 12 State 13 Pin code 14 Telephone Number (with STD code) 15 Mobile Number 16 Amount of transaction (Rs.) 17 Date of transaction D D M M Y Y Y Y 18 In case of transaction in joint names, number of persons involved in the transaction 19 Mode of transaction: Cash, Cheque, Card, Draft/Banker s Cheque, Onlin ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... son 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. 2. The person accepting the declaration shall not accept the declaration where the amount of income of the nature referred to in item 22b exceeds the maximum amount which is not chargeable to tax, unless PAN is applied for and column 21 is duly filled. Instruction: (1) Documents which can be produced in support of identity and address (not required if applied for PAN and item 20 is filled): - Sl. Nature of Document Document Code Proof of Identity Proof of Address A For Individuals and HUF ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... 16 No Yes 17. Landline Telephone bill (Not more than 3 months old) 17 No Yes 18. Water bill (Not more than 3 months old) 18 No Yes 19. Consumer gas card/book or piped gas bill (Not more than 3 months old) 19 No Yes 20. Bank Account Statement (Not more than 3 months old) 20 No Yes 21. Credit Card statement (Not more than 3 months old) 21 No Yes 22. Depository Account Statement (Not more than 3 months old) 22 No Yes 23. Property registration document 23 No Yes 24. Allotment letter of accommodation from Govern ..... X X X X Extracts X X X X X X X X Extracts X X X X
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