“FORM NO. 60 [See second proviso to rule 114B] Form for declaration to be filed by an individual or a person (not being a company or firm) who does not have a permanent account number and who enters into any transaction specified in rule 114B 1 First Name 2 Middle Name Surname 3 Date of Birth/ Incorporation of declarant D D M M Y Y Y Y First Name Father’s Name (in case of individual) Middle Name Surname 4 Flat/ Room No. 5 Floor No. 6 Name of premises 7 Block Name/No. 8 Road/ Street/ Lane 9 Area/ Locality 10 Town/ City 11 District 13 Pin code 16 Amount of transaction (Rs.) 14 Date of transaction 19 Mode of transaction: Cash, 20 Telephone Number (with STD code) D 17 12 D M M Y Y Y Y State 15 Mobile Number 18 In case of transaction in joint names, number of persons involved in the transaction Cheque, Card, Draft/Banker’s Cheque, Online transfer, Other Aadhaar Number issued by UIDAI (if available) D D M M Y Y Y Y 21 If applied for PAN and it is not yet generated enter date of application and acknowledgement number 22 If PAN not applied, fill estimated total income (including income of spouse, minor child etc. as per section 64 of Income-tax Act, 1961) for the financial year in which the above transaction is held 23 24 a Agricultural income (Rs.) b Other than agricultural income (Rs.) Details of document being produced in support of identify in Column 1 (Refer Instruction overleaf) Details of document being produced in support of address in Columns 4 to 13 (Refer Instruction overleaf) Docume nt code Document identification number Name and address of the authority issuing the document Docume nt code Document identification number Name and address of the authority issuing the document Verification I, _______________________________________________ do hereby declare that what is stated above is true to the best of my knowledge and belief. I further declare that I do not have a Permanent Account Number and my/ our estimated total income (including income of spouse, minor child etc. 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 will be less than maximum amount not chargeable to tax. Verified today, the ______________ day of ______________ 20_____ Place: ____________ (Signature of declarant) Note: 1. Before signing the declaration, 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. 2. The person accepting the declaration shall not accept the declaration where the amount of income of the nature referred to in item 22b exceeds the maximum amount which is not chargeable to tax, unless PAN is applied for and column 21 is duly filled.
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