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

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FORM NO. 15H
[See section 197A(1C) and rule 29C]
Declaration under section 197A(1C) to be made by an individual who is of the age of sixty years or more
claiming certain incomes without deduction of tax.
PART I
1
2
1. Name of Assessee (Declarant)
2. PAN of the Assessee
3. Date of Birth
(DD/MM/YYYY)
3
4. Previous year(P.Y.)
(for which
5. Flat/Door/Block No.
6. Name of Premises
declaration is being made)
7. Road/Street/Lane
8. Area/Locality
9. Town/City/District
10. State
11. PIN
12. Email
13. Telephone No. (with STD Code) and Mobile No.
4
14 (a) Whether assessed to tax
: Yes
No
d
(b) If yes, latest assessment year for which assesse
15. Estimated income for which this declaration is
16. Estimated total income of the P.Y. in which income
5
made
mentioned in column 15 to be included
6
17. Details of Form No.15H other than this form filed for the previous year, if any
Total No. of Form No.15H filed
Aggregate amount of income for which Form No.15H
filed
18. Details of income for which the declaration is filed
Sl.
Identification
number
of
Nature of income
Section under which
Amount of income
No.
relevant
investment/account,
tax is deductible
7
etc.
……………………………………….
Signature of the Declarant
8
Declaration/Verification
I……………………………….do hereby declare that I am resident in 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 under sections 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 15 *and aggregate amount of
*income/incomes referred to in column 17 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.
Place:………………………………………………..
……………………………………………………….
Signature of the Declarant
Date: ………………………………………………..

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