FORM NO. 13E
[See rule 28(5)]
Application for a certificate under section 194J(2) of the Income-tax Act, 1961, relating to deduction of income-tax from payments of fees for professional or technical services

To
The Assessing Officer,
……………………..
Sir,
I,………………….[name], of…………….[address] do hereby declare that my total income (including income comprised in payments of the nature referred to in section 194J of the Income-tax Act, 1961) computed in accordance with the provisions of that Act for the previous year relevant to the assessment year……………..* was less than the minimum liable to income-tax / amounted to Rs…………………and I have no reason to expect that my total income (computed as aforesaid) for the three assessment years next following will increase substantially.
2. I, therefore, request that a certificate may be issued to the person(s) responsible for paying any sum by way of fees for * professional/technical services, particulars of which are given in the Schedule hereto, authorising * him/them * not to deduct income-tax/to deduct income-tax at the rate of…………per cent at the time of credit of such income to my account, or as the case may be, payment thereof to me.
3. I hereby declare that what is stated in this application is correct.
Date……………..
Signature
Address
Permanent Account Number
SCHEDULE

SI. No.	Name and address of person(s) responsible for paying fees for *professional/technical services	Amount of fees for *professional/technical services

Date……………..                                                          
Signature
*Score out whichever is not applicable.