Form 15g - Declaration Under Section 197(A)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 A Firm) Claiming Certain Receipts Without Deduction Of Tax

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Form 15G
(See Section 197(A)1, section 197A(1A) and rule 29C)
Declaration Under Section 197(A)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 a firm) claiming certain receipts without deduction of tax
Part I
1. Name of assessee (Declarant):
2. PAN of assessee:
3. Assessment Year
(for which declaration is being made)
4. Flat door / block No.
5.
Name of Premises
6. Status
7. Assessed in which ward/ Circle
8. Road /street/lane
9.
Area / Locality
10. AO Code (under whom assessed last
time)
Area
Range
AO Type
AD No
code
code
11. Town /city/ District
12. State
14. Last assessment year in which assessed
13. Pin
15. E-mail
16. Telephone No. with STD Code
17. Present ward/circle
and mobile No.
19. Name of Business/ Occupation
18. Residential status (within the meaning of
section 6 of the income tax act, 1961
20. Present Ao Code (if not same as above)
21. Jurisdictional Chief commissioner of income tax (if not assessed to income
Area
AO
Range
AD No
tax earlier)
code
Type
code
22. Estimated total income from the sources mentioned below:
(Please tick the relevant box)
Dividend from shares referred to in Schedule I
Interest on securities referred to in Schedule II
Interest on sums referred to in Schedule III
Income form units referred to in Schedule IV

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