Application by a person under section 239A of the Income-tax Act, 1961 for refund of tax deducted

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..... nt, the particulars of which are as under. 2. Detailed particulars (i) Details of applicant: (a) Status (State whether individual, Hindu Undivided Family, Firm, Body of Individuals, Company etc.) (b) Residential status (Resident/ Resident but .....

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..... (e) Mobile Number (f) Country of which the deductee was a resident in the relevant Assessment Year (iii) Details of agreement or other arrangement (Please attach a copy of the same with this application) (a) Date of signing the a .....

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..... (e) Nature of transaction (v) Details of tax deducted on transaction specified in point (iv) above (a) Amount of tax deducted (in INR) (b) Date of tax deduction .....

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..... t transaction (vii) Please state whether tax deducted on similar transaction has been refunded in 3 years prior to the relevant previous year? (If yes, please give the following details) __ Yes No (a) Relevant Assessment Yea .....

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..... as required to be deducted on the income referred to in this form. I further declare that what is stated in this application is correct. I also declare that I am making this application in my capacity as and I am also competent to make this application and verify it. I am holding Permanent Account Number or Aadhaar Number . Date: Signature: Place: Address: . ] .....

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