FORM NO. 15-I
[See rule 29C(3A)]
Declaration under section 197A(1) of the Income-tax Act, 1961, to be made by an individual claiming receipt of any amount referred to in clause (a) of sub-section (2) of section 80CCA without deduction of tax
I,………….. , son/daughter/wife of………….. resident of ………… @ do hereby declare-
1. that the particulars of my account under the National Savings Scheme and the amount of withdrawal are as under :
Particulars of the Post Office where the account under the National Savings Scheme is maintained and the account number |
Date on which the account was opened |
The amount of withdrawal from the account |
|
|
|
2. that my present occupation is…………….
3. that the tax on my estimated total income, including the amount referred to in clause (a) of sub-section (2) of section 80CCA, mentioned in paragraph 1 above, 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;
3A. that my income from *dividend/interest on securities/interest other than “interest on securities”/units/amounts referred to in clause (a) of sub-section (2) of section 80CCA or the aggregate of such incomes, computed in accordance with the provisions of the Income-tax Act, 1961, for the previous year ending on………. relevant to the assessment year 20……………20…………….will not exceed the maximum amount which is not chargeable to income-tax;
4. * 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 or Commissioner of Income-tax, ;
OR
that I was last assessed to income-tax for the assessment year ………….. by the Assessing Officer………Circle/ Ward/District and the permanent account number allotted to me is……….;
5. that I am 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.
4. Before signing the verification, the declarant should satisfy himself that the information furnished in the declaration is true, correct and complete in all respects.
5. Any person making a false statement in the declaration shall be liable to prosecution under section 277 of the Income-tax Act, 1961, and on conviction be punishable-
(i) in a case where tax sought to be evaded exceeds one lakh rupees, with rigorous imprisonment which shall not be less than six months but which may extend to seven years and with fine;
(ii) in any other case, with rigorous imprisonment which shall not be less than three months but which may extend to three years and with fine.
[FOR USE BY THE PERSON TO WHOM THE DECLARATION IS FURNISHED]
1. Name and address of the person responsible for paying the amount referred to in clause (a) of sub-section (2) of section 80CCA.
2. Date on which the declaration was furnished by the declarant.
3. Amount and date of withdrawal from account number ………………….. under the National Savings Scheme.
Forwarded to the Chief Commissioner or Commissioner of Income-tax,
Place…………………
Date ……………………….. Signature of the person responsible for paying any amount referred to in clause (a) of sub-section (2) of section 80CCA
