FORM NO.
15D
[See rule 29B]
Application by a person other than a banking company for a certificate under
section 195(3) of the Income-tax Act, 1961, for receipt of sums other than
interest and dividends without deduction of tax
To,
The [Assessing Officer],
_______________________
Sir,
I, _______________________,being the principal officer of _____________________/
We _____________________________________________________________________________
(name of the person, firm or company entitled to receive sums other than
interest and dividends)
do hereby declare:
(a) that I/_________________________________________________________________
[name of the firm, company, etc.]
am/is a non/resident assessee (not being a banking company) carrying on
business/profession in India through a branch(es) by name(s) ___________
having officer(s) at ______________;
(b) that my head office/the head office of _________________________________
[name of the firm, company, etc.]
is situated at _____________________________________;
[name of the place and country]
(c ) that I/_________________________________________________________________
[name of the firm, company, etc.]
am/is entitled to receive income (other than dividends and interest)
chargeable under the provisions of the Income-tax Act, 1961, during the
financial year 20___ - 20___;
(d) that I/_________________________________________________________________
[name of the firm, company, etc.]
fulfil(s) all the conditions laid down in rule 29(B) of the Income-tax
Rules, 1962.
I, therefore, request that a certificate may be issued authorising me/__________
___________________________________________ to receive income other interest or
[name of the firm, company, etc.]
dividends without deduction of tax under sub-section (1) of section 195 of the
Income-tax Act, 1961, during the financial year 20___ - 20___
I hereby declare that what is stated in this application is correct.
Date : _________ _______________
Signature
_______________
Address
