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(See third
provision to of rule 114B)
Form of
declaration to be filled by a person who does not have
either a Permanent account number or General Index
Register Number and who makes payment in cash in
respect of transaction specified in clauses (a) to (h) of
rule 114B.
1.Full Name and address
of the Declarant
___________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
2. Particulars of
transaction
__________________________________________________
3. Amount of the
transaction
_____________________________________________________
4. Are you assessed to Tax?
Yes/ No
5. If yes,
(i) Details of Ward/
Circle/ Range where the last return of income was
filed.
(ii) Reasons for not
having Permanent Account Number/ General Index
Register Number.
6. Details of the document
being produced in support of address in column(1)
______________________________________________________________________________________
VERIFICATION
I
__________________________________________ do hereby declare
that what is stated above is true to the best of my
knowledge and belief.
Verified today, the
___________ day of _____________ 200
Date ___________
Place __________
_____________________
Signature of
the declarant Instructions:-Documents
which can be produced in support of the address are:-
(a) Ration Card
(b) Passport
(c) Driving Licence
(d) Identity card issued by any institution
(e) Copy of the electricity bill or telephone bill showing
residential address.
(f) Any document or communication issued by any authority of
Central Government,State Government or local bodies showing
residential address.
(g) Any other documentary evidence in support of his address
given in the declaration. |
