FORM NO 13C
[See rule 28(2)]
Application for a certificate under section 194C(4) of the Income-tax Act, 1961, relating to deduction of income-tax from payments made to contractors and sub-contractors

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 194C 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 in pursuance of the contract, 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 sum(s) 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
*Score out whichever is not applicable.

SCHEDULE
SI. No.	Full name and address of the authority/person with whom the contract was made	Date of the contract	Nature of the contract	Date by which work on the contract would be completed	Sums expected to be credited/paid in pursuance of the contract during the current previous year and each of the three immediately succeeding years
1	2	3	4	5	6

Date……………..                                                                                                                Signature