FORM NO. 30
[See rule 41]
Claim for refund of tax

I,…………………………,of………………………[address] do hereby state that my total income computed in accordance with the provisions of the Income-tax Act, 1961, during the year ending on………………………. being the previous year for the assessment year commencing on the 1st April,…………………., amounted to Rs……………………; that the total income-tax chargeable in respect of such total income is Rs………………………and that the total amount of income-tax paid, or treated as paid under
Section 199, is Rs……………………………
I, therefore, request for a refund of Rs…………………
………………
Siganture
I hereby declare that I was resident/resident but not ordinarily resident/non resident during the previous year relevant to the assessment year to which this claim relates and that what is stated in this application is correct.
Dated………………                                                                                
Signature…………….
Notes :
1. The claim should be accompanied by a return of income in the prescribed form unless the claimant has already made such a return to the Assessing Officer.
2. Persons who are non-resident and whose total income is made up only of income taxed at source should make the claim for refund to the Assessing Officer, Non-resident Refund Circle, Bombay.
3. Where any part of the total income consists of dividends, or any other income from which tax has been deducted under the provisions of sections 192 to 194, section 194A and section 195, the claim should be accompanied by the certificates prescribed under section 203.