Form No.15g - Declaration Under Section 197a(1) And Section 197a (1a) Of The Income Tax Act, 1961 To Be Made By An Individual Or A Person (Not Being A Company Or Firm) Claiming Certain Receipts Without Deduction Of Tax Page 2
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2SCHEDULE I ‐
(Details of shares, which stand in the name of the declarant and beneficially owned by him)
No. of
Class of shares & face
Total value
Distinctive numbers
Date(s) on which the shares were acquired
shares
value of each share
of shares
of the shares
by the declarant (dd/mm/yyyy)
‐
SCHEDULE IV
(Details of the mutual fund units held in the name of declarant and beneficially owned by him)
Class of units & face
Distinctive numbers
Date(s) on which the shares were acquired
Name and address of the
Number of
value of each unit
of the units
by the declarant (dd/mm/yyyy)
mutual fund
units
SCHEDULE V ‐
(Details of the withdrawal made from National Savings Scheme)
Particulars of the Post Office where the account under the
Date on which the account
The amount of withdrawal
National Savings Scheme is maintained and the account number
was opened (dd/mm/yyyy)
from the account
Notes:
1. The declaration should be furnished in duplicate.
2. *Delete whichever is not applicable.
#
3. Declaration can be furnished by an individual under section 197A(1) and a person (other than a company or a firm) under section
197A(1A).
4. ** indicate the capacity in which the declaration is furnished on behalf of a HUF, AOP, etc
5. 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 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 6 months but which may extend to seven years and with fine;
i)In any other case, with rigorous imprisonment which shall not be less than 3 months but which
may extend to two years and with fine.
6. The person responsible for paying the income referred to in column 22 of Part I shall not accept the declaration where the amount of income of
the nature referred to in sub‐section (1) or sub‐section (1A) of section 197A 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.";
FOR THE KIND ATTENTION OF DEPOSITORS
Incomplete forms are not accepted by the income tax authorities and therefore, could result in
deduction of tax at source. Please therefore, submit the form completed in all respects.
1. Income-tax, wherever applicable, will be deducted at source in accordance with the Income Tax Act, 1961, as amended to Date.
2. It may be noted that exemption from tax deduction will be granted only from the date of receipt of Form 15G and any tax deducted and
remitted to the government before that date will not be refunded by the company under any circumstances.
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3. The amount of Income-tax deducted at source is remitted to the credit of Central Government before the 7 day of the following month. Any
claim for refund, will have to be made by the depositor to the income-tax authorities by filing a Return of Income.
4. Form 15G is a self declaratory form and does not require attestation by Govt. / Bank Official. However in case of thumb impression, the Form
15G should be attested by a Bank official or by a Gazetted Officer. For the deposit held in the name of Minor, the declaration should be signed by
the Guardian.
5. Before returning the forms, depositors are requested to ensure that all the columns are duly filled up and that the signatures have been affixed.
6. Under the provisions of section 206AA, quoting of Permanent Account Number (PAN) in the declaration form 15G/H in Clause No.5 is
mandatory for non-deduction of Tax at Source. If PAN is not quoted in the declaration form, the form would be invalid and tax will be deducted at a
higher rate of 20%.
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