Form No. 15h - Declaration Under Section 197a(1c) Of The Income-Tax Act, 1961 To Be Made By An Individual Who Is Of The Age Of Sixty Years Or More Claiming Certain Receipts Without Deduction Of Tax

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"FORM NO. 15H
[See Section 197A(1C) and rule 29C(1A)]
Declaration under section 197A(1C) of the Income-tax Act, 1961 to be made by an individual who is of
the age of sixty years or more claiming certain receipts without deduction of tax.
PART-I
1. Name of Assessee (Declarant)
2. PAN of the Assessee
3. Age
4. Assessment Year
(for which is being made)
5. Flat/Door/Block No.
6. Name of Premises
7. Assessed in which
Ward/Circle
8. Road/Street/Lane
9. Area/Locality
10. AO Code(under whom
assessed last
Area
AO
Range
AO No.
Code
Type
Code
11. Town/City/District
12. State
13. PIN
14. Last Assessment Year in
which assessed
15. Email
16. Telephone No. (with STD Code)
17. Present Ward/Circle
and Mobile No.
18. Name of
19. Present AO Code (if not
same as above)
20. Chief Commissioner of Income-tax or Commissioner of
Area
AO
Range
AO No.
Code
Type
Code
Income-tax(if not assessed to Income-tax earlier)
21. Total income from the sources below
(Please the relevant box)
Dividend from shares referred to in Schedule I
Interest on referred to in Schedule II
Interest on sums referred to in Schedule III
Income from units referred to in Schedule IV
The amount of withdrawal referred to in clause (a) of sub-2 of 80CCA referred to in
Schedule V
22. Total income of the previous year in which income in Column 21 is to be included
1

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