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 Page 2

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23. Details of investments in respect of which the declaration is being made:
SCHEDULE-I
(Details of shares, which stand in the name of the declarant and beneficially owned by him)
Class of shares &
Date(s) on which the
Distinctive
No. of
face value of
Total value
shares were acquired
numbers of
shares
each
of shares
by the
the shares
share
declarant(dd/mm/yyyy)
SCHEDULE-II
(Details of securities held in the name of declarant and beneficially owned by him)
Date(s) on which the
Description of
Number of
Amount of
Date of securities
securities were
securities
securities
securities
(dd/mm/yyyy)
acquired by the
declarant(dd/mm/yyyy)
SCHEDULE-III
(Details of the sums given by the declarant on interest)
Name and
Date on which the
address of the
Amount of
Period for which
sums were
Rate of
person to whom
sums given
such sums were
given on
interest
the sums are
on interest
given on interest
interest(dd/mm/yyyy)
given on interest
SCHEDULE – IV
(Details of the mutual fund units held in the name of declarant and beneficially owned by him)
Distinctive Period
Name and
Class of units and
Income in respect
Number of
for which such
address of the
face
of
units
sums were given
mutual fund
value of each unit
units
on interest
2

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