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 Page 2
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1
2PART II
[To be filled by the person responsible for paying the income referred to in column 15 of Part I]
9
1. Name of the person responsible for paying
2. Unique Identification No.
3. PAN of the person responsible for
4. Complete Address
5. TAN of the person responsible for
paying
paying
10
6. Email
7. Telephone No. (with STD Code) and Mobile
8. Amount of income paid
No.
9.
Date
on
which
Declaration
is
received
10. Date on which the income has been paid/credited
(DD/MM/YYYY)
(DD/MM/YYYY)
Place: ………………………………………………..
…………………………………………………
Signature of the person responsible for paying
Date: ……………………………………………….
the income referred to in column 15 of Part I
*Delete whichever is not applicable.
1
As per provisions of section 206AA(2), the declaration under section 197A(1C) shall be invalid if the declarant
fails to furnish his valid Permanent Account Number (PAN).
2
Declaration can be furnished by a resident individual who is of the age of 60 years or more at any time during the
previous year.
3
The financial year to which the income pertains.
4
Please mention “Yes” if assessed to tax under the provisions of Income-tax Act, 1961 for any of the assessment
year out of six assessment years preceding the year in which the declaration is filed.
5
Please mention the amount of estimated total income of the previous year for which the declaration is filed
including the amount of income for which this declaration is made.
6
In case any declaration(s) in Form No. 15H is filed before filing this declaration during the previous
year, mention the total number of such Form No. 15H filed along with the aggregate amount of income
for which said declaration(s) have been filed.
7
Mention the distinctive number of shares, account number of term deposit, recurring deposit, National
Savings Schemes, life insurance policy number, employee code, etc.
8
Before signing the declaration/verification, the declarant should satisfy himself that the information
furnished in this form is true, correct and complete in all respects. Any person making a false statement in
the declaration shall be liable to prosecution under section 277 of the Income-tax Act, 1961 and on
conviction be punishable-
(i) in a case where tax sought to be evaded exceeds twenty-five lakh rupees, with rigorous
imprisonment which shall not be less than six months but which may extend to seven years and
with fine;
(ii) in any other case, with rigorous imprisonment which shall not be less than three months but
which may extend to two years and with fine.
9
The person responsible for paying the income referred to in column 15 of Part I shall allot a unique
identification number to all the Form No. 15H received by him during a quarter of the financial year and
report this reference number along with the particulars prescribed in rule 31A(4)(vii) of the Income-tax
Rules, 1962 in the TDS statement furnished for the same quarter. In case the person has also received
Form No.15G during the same quarter, please allot separate series of serial number for Form No.15H and
Form No.15G.
10
The person responsible for paying the income referred to in column 15 of Part I shall not accept the
declaration where the amount of income of the nature referred to in section 197A(1C) or the aggregate of
the amounts of such income credited or paid or likely to be credited or paid during the previous year in
which such income is to be included exceeds the maximum amount which is not chargeable to tax after
allowing for deduction(s) under Chapter VI-A, if any, or set off of loss, if any, under the head “income
from house property” for which the declarant is eligible. For deciding the eligibility, he is required to
verify income or the aggregate amount of incomes, as the case may be, reported by the declarant in
columns 15 and 17.".
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