Form No. 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 investment
Amount invested
Date of *investment/opening of
Estimated income to be
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
Notes :
1. @ Give complete postal address.
2. The declaration should be furnished in duplicate.
3. *Delete whichever is not applicable.
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