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Statement of Exempt income under clause (4D) of section 10 of the Income-tax Act, 1961

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..... Details of Exempt Income under clause (4D) of section 10 S.No. Nature of Income of the Specified Fund Total Income (In Rs.) Income attributable to units held by non-resident (not being a permanent establishment of a non-resident in India) 8. Income accrued or arisen to, or received as a result of transfer of capital asset referred to in clause (viiab) of section 47, on a recognised stock exchange located in any International Financial Services Centre and where the consideration for such transaction is paid or payable in convertible foreign exchange (A) Total of Column (5) in Part I of Annexure 1 Total of Column (9) in Part I of Annexure 1 9. Income accrued or arisen to, or received as a result of transfer of securities (other than shares in a company resident in India) (B) Total of Column (5) in Part II of Annexure 1 Total of Column (9) in Part II of Annexure 1 10. Income from securities issued by a nonresident (not being a .....

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..... y residents during the previous year Declaration I, ___________________________________________________________(Name in full and in block letters) son/daughter/wife of __________________________________________do hereby declare that: (i) to the best of my knowledge and belief what is stated above and in the Annexure(s), including the documents accompanying such Annexure(s), is correct and complete; (ii) the fund has been granted a certificate of registration as a Category III Alternative Investment Fund and is regulated under the Securities and Exchange Board of India (Alternative Investment Fund) Regulations, 2012, made under the Securities and Exchange Board of India Act, 1992 (15 of 1992); (iii) the fund is located in an International Financial Services Centre; (iv) all the units of the specified fund are held by non-residents other than units held by a sponsor or a manger or those who have become resident during this year subsequent to the previous year in which units were issued. I further declare that during the previous year ..yyyy- yyyy the aggregate value and number of the units, held by resident unit hold .....

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..... ) Capital Gains (In Rs.) Aggregate of daily 'assets under management' of the specified fund held by non-resident unit holders (not being the permanent establishment of a non-resident in India) from the date of acquisition of the capital asset or security to the date of transfer of such capital asset or security Aggregate of daily total 'assets under management' of the specified fund, from the date of acquisition of the capital asset or security to the date of transfer of such capital asset or security. Ratio Income attributable to units held by non-resident (not being a permanent establishment of a non-resident in India) (1) (2) (3) (4) (5) (6) (7) (8) = (6) / (7) (9) = (5) * (8) Part I. Income from transfer of securities referred to in clause (viiab) of section 47, on a recognised stock exchange located in any International Financial Services Centre and where the consideration for such transaction is paid or payable .....

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..... (3) (4) (5) (6) (7) (8) = (6) / (7) (9) = (5) * (8) Total Part II. Income from a securitization trust which is chargeable under the head Profits and gains of business or profession. (1) (2) (3) (4) (5) (6) (7) (8) = (6) / (7) (9) = (5) * (8) Total + add rows as .....

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..... r arisen to, or received as a result of transfer of securities (other than shares in a company resident in India) (B) Total of Column (5) in Part II of Annexure 1 Total of Column (9) in Part II of Annexure 1 10. Income from securities issued by a non-resident (not being a permanent establishment of a non-resident in India) and where such income otherwise does not accrue or arise in India ( D ) Total of Column (5) in Part I of Annexure 2 Total of Column (9) in Part I of Annexure 2 11. Income from a securitisation trust which is chargeable under the head Profits and gains of business or profession (E) Total of Column (5) in Part II of Annexure 2 Total of Column (9) in Part II of Annexure 2 12. Total Exempt Income under clause (4D) of section 10 Declaration I, ______________________________________________ (Name in full an .....

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..... Date of acquisition ( dd/mm/ yyyy ) Date of transfer ( dd/mm /yyyy ) Capital Gain (In Rs) Aggregate of daily assets under management of the specified fund held by non- resident unit holders (not being the permanent establishment of a non-resident in India)from the date of acquisition of the capital asset/ security to the date of transfer of such capital asset/ security Aggregate of daily total assets under management of the specified fund, from the date of acquisition of the capital asset/security to the date of transfer of such capital asset/security. Ratio Income attributable to units held by non-resident (not being a permanent establishment of a non- resident in India) (1) (2) (3) (4) (5) (6) (7) (8) = (6) / (7) (9) = (5) * (8) Part I. Income from of transfer of securities referred to in clause (viiab) of section 47, on a recognised stock exchange located in any Internat .....

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