FORM NO. 10HA
[See rule 29AA]
Form of certificate under second proviso to section 80-O of the Income-tax Act, 1961
PART A
(CERTIFICATE OF FOREIGN INWARD REMITTANCE TO BE GIVEN BY BANK)
                                                                                     ………………Bank
 No………………                                                          Ref. No………………                                                                                                                      Date…………
                                                                                                                   
1. We certify that we have received the following remittance and proceeds thereof were paid :
(a) to beneficiary M/s ……….(Name and address) on...............By Cash……………………..By Pay-Order…………………
By Credit to Current/ Saving/ Cash Credit Account with us/ with our office for beneficiary's account, or
(b) to…………Bank………..on………..for credit of beneficiary of M/s………….`s (Name and address) Account
2. Name and address of remmiter………………
3. Name and address of remitting bank………………
4. Demand Draft/Telegraphic Transfer/Money Transfer No…Dated…..................reign currency amount…..........…..Rupee equivalent……..(Rupees…..) Favouring…..
5. Exchange rate applied
6. Purpose of remittance as stated by remitter * / beneficiary ………………
We also certify that the payment thereof has/ has * not been received in non-convertible rupees or under any special trade or payments agreement.
We confirm that we have obtained reimbursement in any manner approved by the Reserve Bank of India and according to the laws.
 For ……………..Bank
*Strike out whichever is inapplicable.
To
………………..                                
………………………………………Manager
………………………………………….Countersigned
  (name and designation)
  (Address)
PART B
(CERTIFICATE TO BE GIVEN BY ELIGIBLE ASSESSEE)
1. Inward remittance received during the previous year                                        
2.   (i) Whether the convertible foreign exchange in (1) was brought into India   * Yes /No within a period of six months from the end of the previous year                                                                                               
     (ii) If not, whether it was brought into India within such further period in the      * Yes /No previous year as allowed by the Competent Authority                                                                                         
(iii) Specify the amount and the relevant previous year in case such amount is brought into India in convertible foreign exchange beyond the period of six months from the end of relevant previous year and with the approval of the competent authority, where such amount relates to any other previous year. (Specify the authority and the period upto which the approval has been accorded).                                                                         
I certify that the total deduction of Rs……………claimed under section 80-O in respect of assessment year…………..is correctly claimed in accordance with the provisions of the section.
I hereby certify that the above particulars contained in Part A and Part B of this certificate are true and correct to the best of my knowledge and belief and nothing has been concealed therein.
Place…………………                                                    
Date …………                                                                 (Signature)
*Strike out whichever is inapplicable.