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Statement of income paid or credited by investment fund to be furnished under section 115UB of the Income-tax Act 1961

Income Tax - 64D - FORM NO.64D [See Rule 12CB (1)(ii)] 1. Name of the Investment Fund: 2. Address of the registered office: 3. Legal status: [company/trust/limited liability partnership; body corporate] 4. Permanent Account Number: 5. Previous year ending: 6. Name and address of the Directors/Trustees/Partners of the Investment fund*: S.No. Name Address (1) (2) (3) 7. (i) Whether registered as Alternative investment Fund with SEBI under Yes/No* the Securities and Exchange Board of India (Alterna .....

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ired to be set off against the income of the previous year in accordance with clause (i) of sub-section (2) of section 115UB: S.No. Head of Income Amount of loss Amount set off in current year Amount to be carried forward (1) (2) (3) (4) (5) (iii) Aggregate of income of Investment fund after ignoring the loss in (i) above and setting off of losses at (ii) above: (iv) Income under head 'Business & Profession': S.No. Amount Proportion [Column 2/Amount at 9(iii) above] (1) (2) (3) (v) I .....

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ails of person being a unit holder, referred to in sub-section (1) or section 115UB by whom the income is received or in whose name it has been credited: S. No. Name of Unit Holder Address PAN Total amount paid/ credited/ Deemed to be credited Income under the head 'Business or Profession [Column 5 x Column 3(1) of Table at s.no.9(iv)] Income under the head 'Long Term Capital Gains' Income under the head 'Short Term Capital Gains' Income under the head 'Other Sources' .....

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