FORM NO. 15H [See section 197A(1C) and rule 29C] Declaration

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
3. Date of Birth2
1. Name of Assessee (Declarant)
2. PAN of the Assessee1
(DD/MM/YYYY)
4. Previous year(P.Y.)3 (for which
5. Flat/Door/ Block No.
declaration is being made)
8. Area/Locality
7. Road/Street/Lane
9. Town/City/District
11. PIN
12. Email
6 . Name of Premises
10. State
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 any 6
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
Identification number of relevant Nature of income
Sl.
investment/account,
No.
etc.7
Section under which Amount of income
tax is deductible
……………………………………….
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
6. Email
9.
Date
on
received
(DD/MM/YYYY)
4. Complete A ddress
5. TAN of the person responsible for
paying
7. Telephone No. (with STD Code) and Mobile
No.
which
Declaration
Place: ………………………………………………..
Date: ……………………………………………….
is
8. Amount of income paid10
10. Date on which the income has been paid/credited
(DD/MM/YYYY)
…………………………………………………
Signature of the person responsible for paying
the income referred to in column 15 of Part I
*Delete whichever is not applicable. 1 As 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).
2
Declaration can be furnished by a
resident individual who is of the age of 60 years
or more at any time during the previous year.
3
The 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.
5
Please 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.
In 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.
7
Mention the distinctive number of shares, account number of term deposit, recurring deposit,
National Savings Schemes, life insurance policy number, employee code, etc.
8
Before 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.
9
The 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.
10
The 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.".
6