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Ajay 15 G

1. This document is Form No. 15G, a declaration form under section 197A(1) and 197A(1A) of the Indian Income Tax Act of 1961 for individuals claiming certain incomes without deduction of tax. 2. The form provides details of the declarant such as name, PAN, residential status, address and estimated income amounts. 3. By signing the declaration, the individual declares that the incomes referred to in the form are not included in the total income of any other person and that the estimated total income and tax payable for the previous year will be nil.

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52 views1 page

Ajay 15 G

1. This document is Form No. 15G, a declaration form under section 197A(1) and 197A(1A) of the Indian Income Tax Act of 1961 for individuals claiming certain incomes without deduction of tax. 2. The form provides details of the declarant such as name, PAN, residential status, address and estimated income amounts. 3. By signing the declaration, the individual declares that the incomes referred to in the form are not included in the total income of any other person and that the estimated total income and tax payable for the previous year will be nil.

Uploaded by

surendra singh kachhava
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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1FORM NO.

15G

[Seesection 197A(t), 197A(iA) and rulc 29C]


Declaration under section l97A(l) and section I97A(1A) to be made by an
individual or a person (not being a company or firm) claiming certain
incomes rvithout deduction of tax
PART I
Name olAssessce (Declarant) 2. pAN of rlic Assess"",
1.
dr* v (,i"nJs-r.l IVAC PS I L {i G
3. Status2 4. Prer,ious -vear(P.Y.)3 5. Resiclential Status4
(for rvlrich ieclaration is bcing rnade) ?-o 2-l -2*o
]/rvfirrmst'*t
6. Flut,/Door'/ Bloc[ \o. 7. Nanie of Premiscs 8. Road /Streetl'Lane 9. Are;r,/Local;tv Te ,i-Pl AA

1 0. Torun/ Cit_v i District ]gDor -6.11.State H P 12. PIN ,l y jSS I 13. Email
14. Telephone No. (rvith STD 15 (rz) Whether assessed tcl Lax r,Lnder the Yc's Ncr

Code) and Mobile No. lncorne-tax Act, 1961':

fig+,r7 z z-s "1


(&) If -ves, lar;est assessment -vcal for rvhjcir assessecl

16. Estirnated income for rl,hich this dc-claratic-rrr 17. Estiruated total incomc of the P.Y. ir.r u,hich
is rlade incc-rn:e mentioncd in column L6 to be inclLrdecl'

18. Details of Folm No. 15G other than this forrn fileci cluring tire prer.ious vear, if alyT
Totai No. ol Forrn No. 1-5G filed Aggrcgate amount cf incarrne for lr,hich F<;rm No"15G filed

3177
19. Delails of incorne lor u,hich the declzrration is filed

si. ldcnlification numbcr of relevant N:Lture of income Secticxr undcr t,hich ta.r Amount of ilcotne
s
No. .in vestrrr ent,/ zrccount, etc. dedr-ictible
i.s

lo 166 s:.S*g,s 6 2*a FF -wir+ra ya4rl t1z- n 34-tT

t Dectaranle
D eclura t ioru / Veri f ica tionLo
-IlWe....fi,$Y...5r,Cv..&:.1/i........................ .rn-vfour knorvl-
do hereby declarc that to the best of
.I/We declare that
edge and belief r,vhatis stated aboveis corr"ect, cornplete andis trul-v statcd.
the incomes referred to in this forn-r are not includible in the total incorxe of an!'othcr pcrson
-I/We furthcr *otl
urlder sections 60 to 64 af the hrcome-tax Act, 1961. declare that thc tax
m-v/our c'stirnated total income including *incomc/incr-rmcs referred to in colurnn 16
*ancl
.income/incomes refen"ed to in column 18 computed in accordance
aggregate amount of
witil the provisions of the ln come-tax Ac t,1961,for the prcvious ycar endjng on "3.t..lYur.tA .t o.T I
relcvant to the assessment -vear ..Zr,L'2;,.28.&J rvill be nil..IlWe also dcclar-e that
*my/our
-incomc/incomes .and .incorne
referrcd to in column i6 the aggregatc amount of /inc<xres
reiterred to in colulxn 18 ft-rr the previous year ending on re]errant to the
asscssment Year will not exceed the maximum amount r,r,hich is not r-:harge-
able to income-tax.

Signriture. af the l)eciuranre

l" Sr,rbstitutcclbyIT(FourteenthAmdt.)Rulcs2015,rv.e.['. 1-10-2015.Ear]ierForm]*[o. 1,5Grvas


inscrted bl the IT (Fiftli Amclt.) Rules, 1982, rv.e.f .21-5-L982 ar:d later on amended by the
lT (F'itth Amdt.) Ruies, 1989, rv.r.e.f. t-4-1988, lT (Fourteenth Amdt.) Ru1es, 1990, rv.c.f.
20-11-1990 ancl IT (Trvelfth Amiit") Ruies,2002, rv.e.f .21-6-2A02 and substituted bv the IT
(Eiglrth Amclt.) Rr:1es,2003, w.e.f. 9-6-2AA3 and IT (SecondAmdt.) Ru1es, 2A13,r.v.e.f. 19-2-ZAB.

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