1{FORM NO. 60 {[See second proviso to rule 114B} Form for dectaration tobe fled by any person (other than a company or fim) or a foreign company covered by the third proviso to rule 1148, who does nat havea permanent acco ‘number and who enters into any transaction specified in rule 1 Fist Name [IR aly]. Middle Name Sumame KIvIM|A First Father's Name (incase of | Rist, individual) IW) Middle Name UM ‘Surname Flav Room No, Floor No. ‘Name of premises Block Name/No, Road/ Sweev Lane ATi D ~STMSHARA ‘Areal Locality ps— TLW HARA 10 1 EAST CHAMPARa J District TY Stare BLHBR Towal Cy MOILHARE 1 Pin code ‘Telephone Number (with STD code) 15] Mobile Number “Taxpayer identification Number in the country of residence (if covered by third proviso) ‘Amount of transaction (Rs) In case of transaction in Date of transaction 19) joint names, number of Persons involved in the transaction ‘Mode of transaction: L Cash, | Cheque, 1 Card, 1 DrafvBanker's Cheque, -! Online transfer, -1 Other “Aadhaar Number issued by UDDAL available) Ifapplied for PAN and itis not yet generated center date of application and acknowledgement number If PAN not applied, fill estimated total income (inc of Income-tax Act, 1961) forthe financial year in luding which the above transaction is held. income of spouse, minor child ete, as per se a_| Agricultural income (Rs.) b_| Other than agricultural income (Rs.) ¢[i] Income chargeable to ax (for a foreign company) Income not chargeable to tax (for a foreign company) |. Substituted by the IT (Twenty-fourth Amdt) Rules, FT Hest 2023, wef, 10-10-2022UOMAL SEEN g VERIIEDDetails of document being Document | Document Name and address of the authority 24 | produced in suppor of identify | code idemttication _| issuing the document in Column 1 (Refer note number overleap) Details of document being Document | Document Name and address of the authority 25 | produced in support of address | code identification _| issuing the document in Columns 4 t0 13 number (Refer note overleaf) Verification RAT KUMART. yr semen wits ot i DINESH LVAGBR sotny declare tat te best of my knowledge and belief, the information given in this application and documents, if any, accompanying it aro correct and ‘complete and particulars shown therein are truly stated 2. further declare that I Vapplicant does not have a Permanent Account Number and (@) mylour/applicant’s estimated total income (including income of spouse, minor child ete. 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 willbe less than maximum amount not chargeable 10 tax, oF (Gi) the applicant is a foreign company covered by the third proviso to Rule 114B and does not have any income chargeable to ax in India, 3. Talso declare that am making this application for jn my capacity as__ (designation) and. Cea irapicae! es day ot, Jet dah Place: Notes: SiGWaTURE- T. Before signing the declaration, the declarant should satisty himself thatthe information furnished in this form is true, correct and complete inal respects. Any person making 3 false statement in the delaration shall be lable to prosecution Under section 277 of the Income-tax Ac, 1961 and on conviction be punishable, (iyin 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; Gi) in any other ease, wit 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, {i) the amount of income of the nature referred to in tem 23b exceeds the maximum amount which is not chargeable ‘to tax, unless PAN is applied for and column 2 is duly filed; (iy there is income chargeable to tax shown in iter 23c{I)in case of a foreign company. 3. Documents which can be produced in support of identity and address (not required if applied for PAN and item 21 is ei | Ramee Cesc] rtd te fa cote | Sot | acres pa aT coat a 1] ss iar bev pa oe ote oe a pleura ei eral tpn =| bilan ete eee Sete + tear — a ea apa Owe ee AE a ete 3 eae boaeie atte bala sl apa ot yet ae Tepagt } RIAL SEEN £ VERFED Eero SEES ABS ox smn BIGNATURE- disk ale SinghGenifcate of idemtity/address signed by a Member of Parliament or Member of 10 Yes Yes 10. | Legislative Assembly or Municipal Councillor ora Gavetted Officer as per annexure A prescribed in Form 49 11, | Cemtifcate from employer as per annexure B prescribed in Form in Yes Yes 490 12. | Kisan passbook bearing photo 2 Yes No 13. | Ams license 13 Yes No viceren 4 Yes No 14, | Centeal Government Healy Scheme * | Contributory Health Scheme curd 15, | Photo identity ard issued by the govemnment/ Public Secor 5 Yes No Undertaking 16 | Eleticy bill (Not more than 3 months od) 6 Ne Yes 17. | Landline Telephone bill (Not more dan 3 months od) 0 No Yes. 18. [ Wate bill (Not move than 3 months od) 8 No Yes 19, | Consumer gas eardbook o piped gas bill (Not more than 3 ” No Yes smoihs od) 20, | Bank Account Statement (Not more han 3 months) 20 No Yes 21 | Credit Card statement (Not more than 3 sos ol) 21 No Yes Depository Account Statement (Not more than 3 ants od) 22 No Yes Property registration document 23 No Yes [24 Allouent letter of accommodation from Government 24 No Yes 25. | Passport of spouse bearing name ofthe person 25 No Yes 26. [Property tx payment reeipt (Not none than one year ol) 26 No Yes 1B, For Association of persons (Trusts) ‘Copy of trust deed or copy of certificate of repistration issued by 27 Yes Yes Charity Commissioner. . For Association of persons (other than Trusts) or Body of Individuals or Local authority or Artificial Juridical Person) ‘Copy of Agreement or copy of cerificate of registration issued by Chany 8 Yes Yes comimissioner ot Registrar of Cooperative society or any ether competent authority or any other document originating from any Central or State Government Department establishing identity and address of such person. D. For a foreign company 1} Copy of Certificate of Regisiration or incorporation issued in the country where 2» ara na the applicant is located, duly attested by authorised officials of IFSC banking Z| Copy of ax Wlentification number Issued inthe country where the applicants 30 Ye es located, duly atested by authorised officials of IFSC banking unit pee mentioned in the same) ‘To In case of a transaction in the name of a Minor, any of the above-mentioned documents as proof of Tdentity 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, 5. For HUF any document in the name of Karta of HUF is required, 6. Incase the transaction is in the name of more than one person the total number of persons should be mentioned in SSI. No. 19 and the total amount of transaction isto be filled in SI, No. 17. Tn case the estimated total income in column 23b exceeds the maximum amount not chargeable to tax the person should apply for PAN, fill out item 22 and furnish proof of submission of application.) Eup cope: EMP NAME- ABHISHEK SINGH Oates a= signature. 2°24 Abhnbe k Lege