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Form 15H

This document contains a Form 15H declaration. [1] The declaration allows Indian citizens aged 60 or older to file a form claiming certain incomes without tax deduction, [2] The form collects personal details of the declarant such as name, DOB, address, PAN, income types and amounts. [3] The declarant signs declaring the information is true and their total income for the year will not be taxable.

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Nithya Sathyaprasath
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204 views2 pages

Form 15H

This document contains a Form 15H declaration. [1] The declaration allows Indian citizens aged 60 or older to file a form claiming certain incomes without tax deduction, [2] The form collects personal details of the declarant such as name, DOB, address, PAN, income types and amounts. [3] The declarant signs declaring the information is true and their total income for the year will not be taxable.

Uploaded by

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

15H
[See section 197A(1C) and rule 29C]
Declaration under section 197A(1C) to made by an individual who is of the age of sixty years or more
claiming certain incomes without deduction of tax.

PART. I

1. Narrle;ii Assessee (Declarant) 2. PAN oftheAssessee

3. Date of Brith (DD/MMI(Y)

4. Previous year (P.Y.) (forwhich declaration is being made 5. Flat lDoor lBlock No.

3. Name of Premises 7. Road / Street/ Lane 8. Area / Locality

9. Town / City / District 10. State 11. PtN

Gujarat

12. E-mail 13. Telephone No. (with STD Code) and Mobile No.

14. (a) Whether assessed to tax I Yes I No.

(b) lf 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 whidt income mentioned in column 15 to be included

'17. Details of Form No. 15H other thdn this form filled for the previous yeal if any
Total'No. of Forrn No. 15H filed Aggregate amount of income for which Form No. 15H filed

lS. Details of lncome for which the declaration is,filed


Sr. ldentificdtion number of relevant Nature of lncome Section under which tax is Arnount of lncome
No. investmenUaccount, etc. deductible

** Signature
of the Declarant
Declaration / Verification

do hereby declare that I am resident in lndia

within the meaning of section 6 of the lncome-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

imcome of any other person u/s 60 to 64 of the lncome-tax Act, 1961 . I further, declare, that the tax on my estimated total income,

including income/income referred to in column 15 and aggregate amount of income/incomes referred to in column 17 computed

in accordance with the provision of the lncome-tax Act, 1961 , for the previous year ending on relevant to

the assessment year will be nil.

Place:

** Signature of the Declarant


Date

PART.II
[To be filted by the person responsible for paying the income referred to in column 15 of Part l]

1. Name of the person responsible for paying 2.Unique ldentification No.

S.K. DIST. CENTRAL CO. OP. BANK LTD.

3. PAN of the person responsible for paying fuA/MTl019P 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 paid 9. Date on which Declaration is received (DD/MM|/Y)

10. Date on which the income has been paid/credited (DD/MM^/Y)

Place:

Date: Signature of the person responsible for


paying the income referred to in Column
15 of Part I

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