FORM NO. 13
[See rules 28 and 37G]
Application by a person for a certificate under sections 197
and/or 206C(9) of the Income-tax Act, 1961, for no
*deduction/collection of tax or *deduction/
collection of tax at a lower rate
To
1.*I, of do, hereby, request that a certificate may be issued to the person responsible for paying to me the incomes/sum by way of salary/interest on securities/interest other than "interest on securities"/insurance commission/commission (not being insurance commission) or brokerage/commission, etc., on the sale of lottery tickets/fees for professional or technical services/any sum by way of payment to contractors and sub-contractors/dividends/rent/income in respect of units/sum by way of payment of compensation on acquisition of immovable property (strike out whichever is not applicable) authorising him not to deduct income-tax/to deduct income-tax at the rate of per cent at the time of payment to me of such income/sum. The particulars of my income and other details are as per para 2.
and/or
*I, of do, hereby, request that a certificate may be issued to the seller, being the person responsible for collecting the tax from me in respect of the amount payable by me as the buyer of [specify the nature of goods referred to in the Table in sub-section (1) of section 206C]/lessee or licensee of [specify the nature of contract or licence or lease referred to in the Table in sub-section (1C) of section 206C] (Strike out whichever is not applicable) authorizing him to collect income-tax at the rate of per cent at the time of debit of such amount to my account or receipt thereof from me, as the case may be. The particulars of my income and other details are as per para 2.
2. The particulars of my income and other details are as under :
(i.) Status
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(State whether individual, Hindu undivided family, firm, body of individuals, Company, etc.)
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(ii.) Residential status
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(Whether resident / resident but not ordinarily resident/non-resident)
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(iii.) Permanent Account No. (PAN)
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(iv.) Tax Deduction and Collection Account No. (TAN)
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(v) Details of returns/statements which have become due but have not been filed :
Section under which return/statement has become due
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Assessment year/ quarter
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Due date for filing
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Reason for not filing
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(1)
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(2)
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(3)
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(4)
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Section 139
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Section 200
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Section 206C
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(vi) Details of returned income/ assessed income for the last three assessment years:
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(enclose copies of returns of income filed alongwith their enclosures and copies of assessment orders, if assessed, for the last three assessment years.)
Assessment year
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Total income as per return of income
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Total income as per latest assessment
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Total tax including interest payable on returned income
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Total tax including interest payable on assessed income
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(1)
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(2)
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(3)
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(4)
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(5)
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(vii) Details of tax payment for the last three assessment years:
Assessment year
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Total payment of tax including interest
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Tax paid by way of Advance tax
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Credit claimed for tax deduction at source
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Credit claimed for tax collection at source
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Tax paid by way of self assessment tax
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Tax paid in response to notice of demand under section 156
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(1)
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(2)
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(3)
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(4)
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(5)
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(6)
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(7)
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(viii)Details of sales, profit, etc. for the last three previous years in the case of assessee whose income include income under the head "Profits and gains of business or profession": (enclose copies of profit and loss account and balance sheet along with audit report, if audited, for the last three previous years)
Previous year
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Gross sales, turnover receipt of business or profession
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Gross profit
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Net profit
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In rupees
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In percentage to amount stated in column (1)
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In rupees
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In percentage to amount stated in column (1)
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(1)
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(2)
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(3)
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(4)
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(5)
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(6)
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(ix) Details of existing liability under Income-tax Act, 1961 and Wealth-tax Act, 1957:
Assessment Year/ period
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Liability under the Income-tax Act, 1961
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Amount payable under
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the Wealth-tax Act, 1957
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Amount payable in respect of advance-tax
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Amount payable for self- assessment tax
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Amount for which notice of demand under section 156 has been served but not paid
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Amount payable as deductor or collector which had become due but not paid.
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(1)
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(2)
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(3)
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(4)
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(5)
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(6)
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(x) Assessment year to which the payments relate
(xi) Estimated total income of the previous year relevant to the assessment year referred to in (x) above (give detailed computation and basis thereof)
(xii) Total tax including interest payable on the income at (xi)
(xiii) How the liability mentioned in col. (ix) and col. (xii) is proposed to be discharged?
(xiv) Details of payment of advance-tax and tax already deducted/collected for the assessment year relevant to the current previous year till date.
Nature of prepaid tax
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Date of payment/deduction/collection
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Advance tax
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TDS
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TCS
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(xv) Details of income claimed to be exempt and not included in the total income in col. (xi) (Please append a note giving reason for claiming such exemption).
(xvi) Please furnish the particulars in Annexure-I in respect of no deduction of tax or deduction of tax at a lower rate under section 197 and/or in Annexure-II for collection of tax at lower rate under section 206C(9) of the Income-tax Act, as the case may be.
*I, the trustee/co-trustee of do hereby declare that the securities/sums/shares, particulars of which are given in the Annexure, are properly held under trust wholly for charitable or religious purposes and that the income therefrom qualifies for exemption under sections 11 and 13 of the Income-tax Act, 1961.
*I declare that the securities/sums/shares, particulars of which are given in the Schedules above, stand in my name and are beneficially owned by me, and the income therefrom is 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 what is stated in this application is correct.
Date_
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Signature
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Place
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Address
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*Strike out whichever is not applicable.
ANNEXURE I
[For the purpose of tax deduction at source]
Please furnish the particulars with the Schedules below in respect of the payments for which the certificate is sought.
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SCHEDULE I
Descripttion of
securities
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Number of
securities
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Date of securities
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Amount of securities
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Estimated amount of
interest to be received
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(1)
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(2)
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(3)
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(4)
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(5)
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SCHEDULE II
Sl.
No.
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Name and
address of
the person
to whom
the
sums are
given on
Interest
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Amount
of
such sums
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The date
on which
such
sums were
given on
interest
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Period for
which
such
sums were
given on
Interest
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Rate of
interest
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Estimated
amount of
interest
to be
received
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(1)
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(2)
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(3)
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(4)
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(5)
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(6)
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(7)
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SCHEDULE III
Sl.
No
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Name and address of person responsible for paying insurance commission
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Estimated amount of insurance commission
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(1)
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(2)
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(3)
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SCHEDULE IV
Sl.
No.
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Name and
address
of the
company
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No. of
shares
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Class of
shares and
face value
of each
share
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Total face
value of
shares
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Distinctive
numbers of
shares
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Estimated amount
of dividend to be
received
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(1)
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(2)
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(3)
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(4)
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(5)
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(6)
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(7)
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SCHEDULE V
Sl
No.
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Name and
address of the
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Period of
employment
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Amount of salary
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Income from
house
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Income from
sources other
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Estimated total
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employer
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received
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property
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than salary and
income from
house property
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income
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(1)
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(2)
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(3)
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(4)
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(5)
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(6)
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(7)
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SCHEDULE VI
Sl. No.
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Name and address of person responsible for paying rent
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Estimated amount of rent to be
received
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(1)
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(2)
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(3)
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SCHEDULE VII
Sl.
No.
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Name and
Address
of the
mutual
fund
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No. of
units
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Classes of
units and
face value
of each
unit
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Total face
value of
units
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Distinctive
Numbers
of units
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Estimated amount
of income to be
received
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(1)
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(2)
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(3)
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(4)
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(5)
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(6)
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(7)
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SCHEDULE VIII
Sl.
No.
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Name and address of person responsible for paying commission (not being insurance commission referred to in section194D) or brokerage.
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Estimated amount of commission (not being insurance commission referred to in section194D) or brokerage to be received
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(1)
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(2)
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(3)
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SCHEDULE IX
Sl. No.
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Full name and address of the authority/person with whom the contract was made
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Date of the contract
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Nature of the contract
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Date by which work on the contract would be completed
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Sums expected to be credited/paid in pursuance of the contract during the current previous year and each of the three immediatelysucceeding
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years
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(1)
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(2)
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(3)
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(4)
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(5)
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(6)
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SCHEDULE X
Sl.
No.
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Name and address of person(s) responsible for paying commission, remuneration or prize (by whatever name called) on the sale of lottery tickets
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Estimated amount of commission/remuneration/prize to be received(strike out whichever is not applicable)
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(1)
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(2)
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(3)
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SCHEDULE XI
Sl.
No.
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Name and address of person(s) responsible for paying fees for professional/technical services
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Estimated amount of fees for professional/technical services to be received (strike out whichever is not applicable)
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(1)
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(2)
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(3)
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SCHEDULE XII
Sl.
No.
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Name and address of person responsible for
paying compensation or enhanced
compensation or the consideration or
enhanced consideration
on account of compulsory acquisition
of immovable property
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Estimated amount of compensation
or the enhanced compensation or
consideration or the enhanced
consideration
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(1)
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(2)
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(3)
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Date
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Signature
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Place
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Address
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ANNEXURE II
[For the purpose of tax collection at source]
Please furnish particulars of the amounts payable in respect of which the certificate is sought in the schedules below:-
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SCHEDULE I
Sl.
No.
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Full name and
address of
the seller
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Date of sale with
reference
number of
such sale
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Nature and
descripttion of
the goods sold
and details
of sale
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Amounts expected to be
debited/ paid in pursuance
of the sale during the
current financial year and
each of the three
immediately succeeding
years.
|
(1)
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(2)
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(3)
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(4)
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(5)
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SCHEDULE II
Sl. No.
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Full name and address of the person granting lease or licence
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Date of grant of lease or licence or contract or transfer of right with reference number
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Nature of contract or licence or lease and descripttion and details of the contract
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Amounts expected to be debited/ paid in pursuance of the contract during the current financial year and each of the three immediately succeeding years.
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(1)
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(2)
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(3)
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(4)
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(5)
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Date
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Signature of the buyer
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Full Name
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Designation
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