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 Page 2

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The amount of withdrawal referred to in section 80CCA(2) (a) from NSS referred to in Schedule V
23. Estimated total income of the previous year in which income mentioned in column 22 is to be included
24. Details of investment in respect of which the declaration is being made
SCHEDULE-I
(Details of shares, which stand in the name of the declarant and beneficially owned by him)
No. of shares
Class of shares &
Total value of shares
Distinctive no. of
Date(s) on which the
face value of each
shares
shares were
share
acquired by the
declarant
(dd/mm/yy)
SCHEDULE- II
(Details of the securities held in the name of declarant and beneficially owned by him)
Description of
Number of
Date (s) of
Amount of
Date (s) on which the
Securities
Securities
Securities
Securities
securities were acquired by
the declarant
SCHEDULE- III
(Details of the sums given by the declarant on interest)
Name and address of the
Amount of
Date on which
Period for which such
Rate of interest
person to whom the
such sums
sums were
sums were given on
sums are given on
given on
interest
interest
interest

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