FORM NO. 15H
[See section
197A(1C) and rule 29C]
Declaration under section 197A(1C) to be made by
an individual who is
of the age of sixty years or more
claiming certain incomes without
deduction of tax.
PART - I
1.
Name of Assessee (Declarant)
|
2. PAN of
the Assessee1
|
3. Date of Birth2
(DD/MM/YYYY)
|
|||||||||||
4. Previous year(P.Y.)3 (for which
declaration is being made)
|
5. Flat/Door/Block No.
|
6. Name of Premises
|
|||||||||||
7. Road/Street/Lane
|
8.
Area/Locality
|
9.
Town/City/District
|
10. State
|
||||||||||
11.
PIN
|
12.
Email
|
13.
Telephone No. (with STD
Code) and Mobile No.
|
|||||||||||
14 (a) Whether
assessed to tax4:
Yes
|
No
|
||||||||||||
(b) If yes, latest assessment year for which assessed
|
|||||||||||||
15. Estimated income
for which
this
declaration is made
|
16. Estimated total income of the P.Y. in which income mentioned in
column 15 to be
included5
|
||||||||||||
17. Details of Form No.15H other than this form filed
for the previous year, if any6
|
|||||||||||||
Total No. of Form No.15H
filed
|
Aggregate amount of income
for which Form No.15H filed
|
||||||||||||
18. Details of income for which the declaration is filed
|
|||||||||||||
Sl.
No.
|
Identification number of relevant investment/account, etc.7
|
Nature
of income
|
Section under which tax
is deductible
|
Amount of income
(Principal
Amount)
|
|||||||||
……………………………………….
Signature of the Declarant
Declaration/Verification8
I……………………………….do hereby
declare that I am resident in India within the meaning
of section 6 of the Income-tax Act, 1961. I also hereby declare that to the best of my knowledge
and belief what is stated above is correct,
complete and is truly stated
and that the incomes referred to in this form are not includible in the total income
of any other person under sections
60 to 64 of the Income-tax
Act, 1961. I further declare that the tax on my estimated
total income
including *income/incomes referred
to in
column 15
*and aggregate
amount of
*income/incomes
referred to in column 17 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.
Place:………………………………………………..
Date: ………………………………………………..
|
……………………………………………………….
Signature
of the Declarant
|
PART – II
[To be filled by the person responsible
for
paying the income referred to
in column 15 of Part I]
1. Name of the person responsible for
paying
|
2. Unique
Identification No.9
|
||||
3. PAN
of the
person responsible
for paying
|
4.
Complete Address
|
5. TAN of the
person responsible
for paying
|
|||
6. Email
|
7. Telephone No. (with STD Code) and Mobile No.
|
8. Amount of
income paid10
|
|||
9. Date on which Declaration is received (DD/MM/YYYY)
|
10. Date on which
the income has been
paid/credited (DD/MM/YYYY)
|
||||
Place: ……………………………………………….. …………………………………………………
Signature of the person responsible for paying Date:
………………………………………………. the income
referred to in column 15 of Part I
*Delete whichever is not applicable.
1As per provisions of section
206AA(2), the declaration under section 197A(1C) shall be invalid
if the declarant fails
to furnish his valid Permanent
Account Number
(PAN).
2Declaration can be furnished by a resident individual who is of the age of 60 years or more at any time during the
previous year.
3The financial year to which the
income pertains.
4 Please mention
“Yes” if
assessed to tax under the provisions of Income-tax Act, 1961 for any of the assessment year out of six assessment years preceding the year
in which the declaration is filed.
5Please mention the amount of estimated
total income of the previous
year for which the declaration is filed
including the amount of income for which this
declaration is made.
6In case any declaration(s) in Form No. 15H is filed before
filing this declaration during the previous year, mention the total number of such Form No. 15H filed along with the aggregate amount of income for which said declaration(s) have been filed.
7Mention the distinctive number of shares, account number of term deposit,
recurring deposit,
National Savings
Schemes, life insurance policy
number, employee code, etc.
8Before signing the declaration/verification, 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.
9The person responsible for paying
the income referred to in column 15 of Part I shall
allot a unique identification number to all the Form No. 15H received by him during a quarter of the financial year and report this reference number along with the particulars prescribed
in rule 31A(4)(vii) of the Income-tax Rules, 1962 in the TDS statement
furnished for the same quarter. In case the person has also received
Form No.15G during the same
quarter, please allot separate series of serial number for Form No.15H and Form No.15G.
10The person responsible for paying the income referred
to in column 15 of Part I shall not accept the declaration where the
amount of income of
the nature referred
to in section 197A(1C)
or the aggregate of the amounts of such income credited or paid or likely to be credited or paid during the previous year in which such income is to be included exceeds the maximum amount which is not chargeable to tax after
allowing for deduction(s) under Chapter VI-A, if any, or set off of loss, if any, under the head “income from house property” for which the declarant is eligible. For deciding the eligibility, he is required
to verify income
or the aggregate amount of incomes, as the case may be, reported by the declarant
in columns 15 and 17.".
