Form 15h - Declaration Under Sub-Section (1c) Of Section 197a Of The Income-Tax Act, 1961, To Be Made By An Individual Who Is Of The Age Of Sixty-Five Years Or More Claiming Certain Receipts Without Deduction Of Tax
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1
2FORM NO. 15H
[See rule 29C(1A)]
Declaration under sub-section (1C) of section 197A of the Income-tax Act,
1961, to be made by an individual who is of the age of sixty-five years or more
claiming certain receipts without deduction of tax
I,
son/daughter/wife of
resident of
@ do
hereby declare-
1. that the shares/securities/sums, particulars of which are given in the Schedule below, stand in my
name and are beneficially owned by me, and the dividend/interest in respect of such securities/sums
and/or income in respect of units is/are not includible in the total income of any other person under
sections 60 to 64 of the Income-tax Act, 1961;
OR
that the particulars of my account under the National Savings Scheme and the amount of withdrawal
are as per the Schedule below:
SCHEDULE
Description and details of
Amount invested
Date of investment/opening of
Estimated income to be
investment
account
received
2. that my present occupation is
;
3. that I am of the age of
years and am entitled to a deduction from the amount of
income-tax on my total income referred to in section 88B;
4. that the tax on my estimated total income, including income/incomes referred to in the Schedule
below 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;
5.
that I have not been assessed to income-tax at any time in the past but I fall within the
jurisdiction of the Chief Commissioner of Income-tax
or Commissioner of Income-tax
OR
that I was last assessed to income-tax for the assessment year
by the Assessing
Officer
. Circle/Ward and the Permanent Account Number allotted to me is
;
6. that I am/am not resident in India within the meaning of section 6 of the Income-tax Act, 1961;
Signature of the declarant
Verification
I
do hereby declare that to the best of my knowledge and belief what is stated above is
correct, complete and is truly stated.
Verified today, the
day of
Place
Signature of the declarant
PART II
[FOR USE BY THE PERSON TO WHOM THE DECLARATION IS FURNISHED]
1. Name and address of the person responsible
for paying the income, mentioned in paragraph 1
of the declaration
2. Date on which the declaration was furnished by
the declarant
3. Date of declaration, distribution or payment of
dividend/withdrawal
from
account
number
under the National Savings Scheme.
4. Period in respect of which dividend has been
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