INCOME -TAX RULES, 1962

“FORM NO. 60 (See second proviso to rule 114B)

Form for declaration to be filed by an individual or a person (not being a company or firm) who does not have a permanent
account number and who enters into any transaction specified in rule 114B

1 First Name 2 Date of Birth/ Incorporation of declarant

Middle Name D D M M Y Y Y Y
Surname

3 Father’s Name (in case of individual) First Name

Middle Name
Surname
4 Flat/ Room No. 5 Floor No.
6 Name of premises 7 Block Name/No.
8 Road/ Street/ Lane 9 Area/ Locality
10 Town/ City 11 District 12 State

13 Pin code 14 Telephone Number (with STD code) 15 Mobile Number

16 Amount of transaction (Rs.)
In case of transaction in joint names, number of per-
sons involved in the transaction
18
17 Date of transaction D D M M Y Y Y Y

19. Mode of transaction: Cash, Cheque, Card Draft/Banker’s Cheque, Online transfer, Other
20 Aadhaar Number issued by UIDAI (if available)
If applied for PAN and it is not yet generated enter date D D M M Y Y Y Y
21
of application and acknowledgement number

If PAN not applied, fill estimated total income (including income of spouse, minor child etc. as per section 64 of Income-tax Act, 1961) for the financial
22
year in which the above transaction is held

a. Agricultural income (Rs.)

b. Other than agricultural income (Rs.)
23 Details of document being produced in Document code Document identification number Name and address of the authority
support of identify in Column 1 (Refer issuing the document
Instruction overleaf)
24 Details of document being produced in Document code Document identification number Name and address of the authority
support of identify in Column 1 (Refer issuing the document
Instruction overleaf)

Verification

I, _______________________________________________ do hereby declare that what is stated above is true to the best of my knowledge and belief. I further declare
that I do not have a Permanent Account Number and my/ our estimated total income (including income of spouse, minor child etc. as per section 64 of Income-tax Act,
1961) computed in accordance with the provisions of Income-tax Act, 1961 for the financial year in which the above transaction is held will be less than maximum amount
not chargeable to tax.

Verified today, the ______________ day of ______________ 20_____

Place: ____________ (Signature of declarant)

Note:
1.Before signing the declaration, the declarant should satisfy himself that the information furnished in this form is true, correct and complete in all respects. 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 twenty-five 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 two years and with fine.
2. The person accepting the declaration shall not accept the declaration where the amount of income of the nature referred to in item 22b exceeds the maximum amount
Version 2.0/July’18

which is not chargeable to tax, unless PAN is applied for and column 21 is duly filled.

PNB MetLife India Insurance Company Limited

Registered office: Unit No. 701, 702 & 703, 7th Floor, West Wing, Raheja Towers, 26/27 M G Road, Bangalore -560001, Karnataka. IRDA of India Registration number 117.
CI No. U66010KA2001PLC028883 Call us Toll-free at 1-800-425-6969, Website: www.pnbmetlife.com, Email: [email protected] or write to us 1st Floor,
Techniplex -1,Techniplex Complex, Off Veer Savarkar Flyover, Goregaon (West), Mumbai - 400062. Phone: +91-22-41790000, Fax: +91-22-41790203
 Instruction:
(1) Documents which can be produced in support of identity and address (not required if applied for PAN and item 20 is filled): -

Sl. Nature of Document Document Proof of Proof of

Code Identity Address
A For Individuals and HUF
1. AADHAR card 01 Yes Yes
2. Bank/Post office passbook bearing photograph of the person 02 Yes Yes
3. Elector’s photo identity card 03 Yes Yes
4. Ration/Public Distribution System card bearing photograph of the person 04 Yes Yes
5. Driving License 05 Yes Yes
6. Passport 06 Yes Yes
7. Pensioner Photo card 07 Yes Yes
8. National Rural Employment Guarantee Scheme (NREGS) Job card 08 Yes Yes
9. Caste or Domicile certificate bearing photo of the person 09 Yes Yes
10. Certificate of identity/address signed by a Member of Parliament or Member
of Legislative Assembly or Municipal Councillor or a Gazetted Officer as 10 Yes Yes
per annexure A prescribed in Form 49A
11. Certificate from employer as per annexure B prescribed in Form 49A 11 Yes Yes
12. Kisan passbook bearing photo 12 Yes No
13. Arm’s license 13 Yes No
14. Central Government Health Scheme /Ex-servicemen Contributory Health
14 Yes No
Scheme card
15. Photo identity card issued by the government./ Public Sector Undertaking 15 Yes No
16. Electricity bill (Not more than 3 months old) 16 No Yes
17. Landline Telephone bill (Not more than 3 months old) 17 No Yes
18. Water bill (Not more than 3 months old) 18 No Yes
19. Consumer gas card/book or piped gas bill (Not more than 3 months old) 19 No Yes
20. Bank Account Statement (Not more than 3 months old) 20 No Yes
21. Credit Card statement (Not more than 3 months old) 21 No Yes
22. Depository Account Statement (Not more than 3 months old) 22 No Yes
23. Property registration document 23 No Yes
24. Allotment letter of accommodation from Government 24 No Yes
25. Passport of spouse bearing name of the person 25 No Yes
26. Property tax payment receipt (Not more than one year old) 26 No Yes
B For Association of persons (Trusts)
Copy of trust deed or copy of certificate of registration issued by Charity
27 Yes Yes
Commissioner
C For Association of persons (other than Trusts) or Body of Individuals or Local
authority or Artificial Juridical Person)
Copy of Agreement or copy of certificate of registration issued by Charity
commissioner or Registrar of Cooperative society or any other competent
28 Yes Yes
authority or any other document originating from any Central or State Government
Department establishing identity and address of such person.

(2) In case of a transaction in the name of a Minor, any of the above mentioned documents as proof of Identity and Address of any of parents/
guardians of such minor shall be deemed to be the proof of identity and address for the minor declarant, and the declaration should be signed by
the parent/guardian.
(3) For HUF any document in the name of Karta of HUF is required.
(4) In case the transaction is in the name of more than one person the total number of persons should be mentioned in Sl. No. 18 and the total amount
of transaction is to be filled in Sl. No. 16.
In case the estimated total income in column 22b exceeds the maximum amount not chargeable to tax the person should apply for PAN, fill out item
21 and furnish proof of submission of application.
Version 2.0/July’18