FORM NO. 15D
[See rule 29B]
Application by a person other than a banking company for a certificate under section 195(3) of the Income-tax Act, 1961, for receipt of sums other than interest and dividends without deduction of tax

To
The Assessing Officer,
Sir,
I, , being the principal officer of we [name of the person, firm or company entitled to receive sums other than interest and dividends] do hereby declare :
(a) that I/ [name of the firm, company, etc.] am/is a non-resident assessee (not being a banking company) carrying on business/profession in India through a branch(es) by name(s) having office(s) at ;
(b) that my head office/the head office of [name of the firm, company, etc.] is situated at [name of the place and country]
(c) that I/ [name of the firm, company, etc.] am/is entitled to receive income (other than dividends and interest) chargeable under the provisions of the Income-tax Act, 1961, during the financial year ;
(d) that I/ [name of the firm, company, etc.] fulfil(s) all the conditions laid down in rule 29B of the Income-tax Rules, 1962.
I, therefore, request that a certificate may be issued authorising me/ [name of the firm, company, etc.] to receive income other than interest or dividends without deduction of tax under sub-section (1) of section 195 of the Income-tax Act, 1961, during the financial year
I hereby declare that what is stated in this application is correct.
Date………                                                                            
Signature
Address