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Statement of income distributed by a business trust to be furnished under section 115UA of the Income-tax Act, 1961

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..... ndia (Infrastructure Investment Trusts) Regulations, 2014 7. Whether the units of the business trust are listed on any recognised stock exchange at any time during previous year Yes/No 8. Aggregate income of the Business trust from all sources (9+11+13+15+17) 9. Income by way of interest referred to in clause (23FC) of section 10 10. Proportion of 9 to 8 11. Income by way of renting or leasing or letting referred to in clause (23FCA) of section 10 12. Proportion of 11 to 8 13. Income by way of dividend referred to in clause (23FC) of section 10 in a case where the special purpose vehicle has exercised option under section 115BAA 14. Proportion of 13 to 8 15. Income by way of dividend ref .....

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..... tion (2) of section 56 during the previous year or during any earlier previous year(s), in the following format:-  S.No. Previous year No. of units Aggregate amount as referred to in clause (xii) of sub-section (2) of section 56 distributed with respect to such units during such previous year (1) (2) (3) (4)                 21. Details of persons being unit holders, referred to in section 115UA to whom the amount referred to in Sl. No. 20 is distributed, in the following format:- S. No. Name (s) Address(es) Permanent Account Number or Aadhaar Number Number of units Amount as referred to in clause (xii) of subsection (2) of section 56 distributed with respect to one u .....

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..... ...........................  Place .......................................                Signature ............... Verification I/We*  .....................................................................................................................  have  examined the books of account and other documents showing the particulars of income earned and the income distributed to the unit holders by the ..................... (name of the Business trust) for the previous year ending ..................... 2. I/We declare that the above particulars are true and correct to the best of my/our knowledge and belief.  Place ...................... .....

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..... income [Column 5x Sl. No.14] 1 2 3 4 5 6 7 8               " 3. Substituted vide Notification No. 95/2019 dated 06-11-2019 w.e.f. 01-09-2019 before it was read as "PAN" 4. Substituted vide Notification No. 17/2025 dated 24-02-2025 before it was read as, "1[FORM NO. 64A [See rule 12CA(2)(i)] Statement of income distributed by a business trust to be furnished under section 115UA of the Income-tax Act, 1961 1.  Name of the business trust 2.  Address of the registered office 3.  Permanent Account Number 4.  Previous year ending 5.  Name and address of the trustees of the business trust 6.  Date of registration of the bu .....

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..... 2 3 4 5 6 7 8 9";                 ]   Enclose a copy of the certificate of registration under the Securities and Exchange Board of India Act, 1992, (15 of 1992). Enclose a copy of the trust deed registered under the provisions of the Registration Act, 1908, (16 of 1908). Enclose audited accounts including balance sheet, annual report, if any, with certified copies of income and appropriation towards distribution of income. I,------------------------------------------------------------------------------------------------------------------------- (Name in full and in block letters) son/daughter/wife of -------------------------------------------------------------- do hereby s .....

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