FORM 15G

FORM NO. 15G

[See section 197A(1), 197A(1A) and rule 29C]
Declaration under section 197A (1) and section 197A(1A) to be made by an individual or a person (not being a company or firm) claiming certain incomes without deduction of tax.

PART I

1. Name of Assessee (Declarant):

2. PAN of the Assessee:

3. Status: -- Select -- Individual HUF AOP BOI

4. Previous year (P.Y.):

5. Residential Status: -- Select -- Resident Non-Resident Indian Resident but Not Ordinarily Resident

6. Flat/Door/Block No.:

7. Name of Premises:

8. Road/Street/Lane:

9. Area/Locality:

10. Town/City/District:

11. State:

12. PIN Code:

13. Email:

14. Telephone No.:

15 (a) Whether assessed to tax:

Yes No

(b) Latest assessment year:

16. Estimated income:

17. Estimated total income:

18. Details of Form No. 15G:

Total No. of Form No. 15G filed:

Aggregate amount of income:

19. Details of income for which the declaration is filed:

Sl. No.	Identification number	Nature of income	Section	Amount
1
2

……………………………………….

Signature of the Declarant

Declaration/Verification

I/We do hereby declare that to the best of my/our knowledge and belief what is stated above is correct, complete and is truly stated. I/We declare that the incomes referred to in this form are not includible in the total income of any other person under sections 60 to 64 of the Income-tax Act, 1961. I/We further declare that the tax on my/our estimated total income including income/incomes referred to in column 16 and aggregate amount of income/incomes referred to in column 18 computed in accordance with the provisions of the Income-tax Act, 1961, for the previous year ending on relevant to the assessment year will be nil. I/We also declare that my/our income/incomes referred to in column 16 and the aggregate amount of income/incomes referred to in column 18 for the previous year ending on relevant to the assessment year will not exceed the maximum amount which is not chargeable to income-tax.

Place:

Signature of the Declarant

Date:

PART II [To be filled by the person responsible for paying]

1. Name of payer:

2. Unique Identification No.:

3. PAN of payer:

4. Complete Address:

5. TAN of payer:

6. Email:

7. Telephone No.:

8. Amount of income paid:

9. Date declaration received:

10. Date income paid/credited:

Place:

Signature of the person responsible for paying

Date:

*Delete whichever is not applicable.
Note: As per provisions of section 206AA(2), the declaration under section 197A(1) or 197A(1A) shall be invalid if the declarant fails to furnish his valid Permanent Account Number (PAN).