Form No. 15h - Declaration Under Section (1c) 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 Receipt Without Deduction Of Tax

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Form No. 15H
[ See rule 29C (1A) ]
Declaration under section (1C) 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 receipt without deduction of tax
I/We*
*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
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 section 60 to 64 of the Income-tax Act, 1961;
OR
* that the particulars of my account under the National Saving Scheme and the amount of withdrawal are as per the
schedule below ;
Date of *investment /
Estimated income to
Description and details of investment
Amount invested
opening of account
be received
2.
that *my/our present occupation is
3.
that I am 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 / We have not been assessed to income-tax at any time in the past but I fall within the jurisdiction of the Chief
Commissioner or 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 / District and the permanent account number allotted to me / us 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 best of my
knowledge and belief what is stated above is correct, complete and is truly stated.
Verified today, the
day of
20
Place .........................
..........................................
Signature of the declarant

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