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 3

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SCHEDULE-V
(Details of the withdrawal made from National Savings Scheme)
Particulars of the Post Office
where the account under the
The amount of
Date on which the account was
National Savings Scheme is
withdrawal from the
opened(dd/mm/yyyy)
maintained and the account
account
number
…………………………………………………………….
Signature of the Declarant
Declaration/Verification
I……………………………….do hereby declare that I am resident i n India within the meaning of section 6 of the
Income-tax Act, 1961. I also, hereby declare that to the best of my knowledge and belief what is stated
above is correct, complete and is truly stated and that the incomes referred to in this form are not
includible in the total income of any other person u/s 60 to 64 of the Income-tax Act, 1961. I further,
declare that the tax on my estimated total income, including *income/incomes referred to in column 21
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.
…………………………………….
Signature of Declarant
Place: …………………………………………….
Date: ………………………………………………
3

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