Form 15g - Declaration Under Section 197a (1) And Section 197a(1a)
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1
2"FORM NO. 15G
[See section 197A(1), 197A(1A) and rule 29C]
Declaration under section 197A (1) and section 197A(1A) to be made by an individual or a person (not being
a company or firm) claiming certain incomes without deduction of tax.
PART I
1
1. Name of Assessee (Declarant)
2. PAN of the Assessee
2
3
4
3. Status
4. Previous year(P.Y.)
5. Residential Status
(for which declaration is being made)
6. Flat/Door/Block No.
7. Name of Premises
8. Road/Street/Lane
9. Area/Locality
10. Town/City/District
11. State
12. PIN
13. Email
14. Telephone No. (with STD
15 (a) Whether assessed to tax under the
Yes
No
Code) and Mobile No.
5
Income-tax Act, 1961
:
(b) If yes, latest assessment year for which assessed
16. Estimated income for which this declaration is made
17. Estimated total income of the P.Y. in which
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income mentioned in column 16 to be included
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18. Details of Form No. 15G other than this form filed during the previous year, if any
Total No. of Form No. 15G filed
Aggregate amount of income for which Form No.15G filed
19. Details of income for which the declaration is filed
Sl.
Identification number of relevant
Nature of income
Section under which tax
Amount of income
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No.
investment/account, etc.
is deductible
……………………………………….
9
Signature of the Declarant
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Declaration/Verification
*I/We………………………………do hereby declare that to the best of *my/our knowledge and belief what is
stated above is correct, complete and is truly stated. *I/We declare 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/We further
declare that the tax *on my/our estimated total income including *income/incomes referred to in column 16 *and
aggregate amount of *income/incomes referred to in column 18 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. *I/We also declare that *my/our *income/incomes referred to in column 16 *and the aggregate amount of
*income/incomes referred to in column 18 for the previous year ending on .................... relevant to the assessment
year .................. will not exceed the maximum amount which is not chargeable to income-tax.
Place: ……………………………………………..
…………………………………………………………….
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Signature of the Declarant
Date: ………………………………………………..
PART II
[To be filled by the person responsible for paying the income referred to in column 16 of Part I]
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1. Name of the person responsible for paying
2. Unique Identification No.
3. PAN of the person
4. Complete Address
5. TAN of the person responsible for paying
responsible for paying
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6. Email
7. Telephone No. (with STD Code) and Mobile No.
8. Amount of income paid
9.
Date
on
which
Declaration
is
received
10. Date on which the income has been paid/credited
(DD/MM/YYYY)
(DD/MM/YYYY)
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