Application format for Non claiming of 10B Exemption

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

The Assessing Officer,

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

(State whether individual, Hindu undivided family, firm, body of individuals, Company, etc.)

(ii.) Residential status

(Whether resident / resident but not ordinarily resident/non-resident)

(iii.) Permanent Account No. (PAN)

(iv.) Tax Deduction and Collection Account No. (TAN)

(v) Details of returns/statements which have become due but have not been filed :

Section under which return/statement has become due	Assessment year/ quarter	Due date for filing	Reason for not filing
(1)	(2)	(3)	(4)
Section 139
Section 200
Section 206C

(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	Total income as per return of income	Total income as per latest assessment	Total tax including interest payable on returned income	Total tax including interest payable on assessed income
(1)	(2)	(3)	(4)	(5)

(vii) Details of tax payment for the last three assessment years:

Assessment year	Total payment of tax including interest	Tax paid by way of Advance tax	Credit claimed for tax deduction at source	Credit claimed for tax collection at source	Tax paid by way of self assessment tax	Tax paid in response to notice of demand under section 156
(1)	(2)	(3)	(4)	(5)	(6)	(7)

(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		Gross sales, turnover receipt of business or profession		Gross profit					Net profit
				In rupees		In percentage to amount stated in column (1)		In rupees			In percentage to amount stated in column (1)
(1)	(2)		(3)		(4)		(5)			(6)

(ix) Details of existing liability under Income-tax Act, 1961 and Wealth-tax Act, 1957:

Assessment Year/ period

Liability under the Income-tax Act, 1961

Amount payable under

[ITR62;13,1] Printed

the Wealth-tax Act, 1957
Amount payable in respect of advance-tax		Amount payable for self- assessment tax		Amount for which notice of demand under section 156 has been served but not paid			Amount payable as deductor or collector which had become due but not paid.
(1)	(2)		(3)		(4)	(5)		(6)

(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	Date of payment/deduction/collection
Advance tax
TDS
TCS

(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_

Signature

Place

Address

*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.

[ITR62;13,1] Printed

SCHEDULE I

Descripttion of

securities

Number of

securities

Date of securities

Amount of securities

Estimated amount of

interest to be received

(1)

(2)

(3)

(4)

(5)

SCHEDULE II

Sl.

No.

Name and

address of

the person

to whom

the

sums are

given on

Interest

Amount

such sums

The date

on which

such

sums were

given on

interest

Period for

which

such

sums were

given on

Interest

Rate of

interest

Estimated

amount of

interest

to be

received

(1)

(2)

(3)

(4)

(5)

(6)

(7)

SCHEDULE III

Sl.

Name and address of person responsible for paying insurance commission

Estimated amount of insurance commission

(1)

(2)

(3)

SCHEDULE IV

Sl.

No.

Name and

address

of the

company

No. of

Class of

shares and

face value

of each

Total face

value of

Distinctive

numbers of

Estimated amount

of dividend to be

received

(1)

(2)

(3)

(4)

(5)

(6)

(7)

SCHEDULE V

No.

Name and

address of the

Period of

employment

Amount of salary

Income from

house

Income from

sources other

Estimated total

[ITR62;13,1] Printed

employer

received

property

than salary and

income from

house property

income

(1)

(2)

(3)

(4)

(5)

(6)

(7)

SCHEDULE VI

Sl. No.

Name and address of person responsible for paying rent

Estimated amount of rent to be

received

(1)

(2)

(3)

SCHEDULE VII

Sl.

No.

Name and

Address

of the

mutual

fund

No. of

units

Classes of

units and

face value

of each

unit

Total face

value of

units

Distinctive

Numbers

of units

Estimated amount

of income to be

received

(1)

(2)

(3)

(4)

(5)

(6)

(7)

SCHEDULE VIII

Sl.

No.

Name and address of person responsible for paying commission (not being insurance commission referred to in section194D) or brokerage.

Estimated amount of commission (not being insurance commission referred to in section194D) or brokerage to be received

(1)

(2)

(3)

SCHEDULE IX

Sl. No.

Full name and address of the authority/person with whom the contract was made

Date of the contract

Nature of the contract

Date by which work on the contract would be completed

Sums expected to be credited/paid in pursuance of the contract during the current previous year and each of the three immediatelysucceeding

[ITR62;13,1] Printed

years
(1)	(2)	(3)	(4)	(5)	(6)

SCHEDULE X

Sl.

No.

Name and address of person(s) responsible for paying commission, remuneration or prize (by whatever name called) on the sale of lottery tickets

Estimated amount of commission/remuneration/prize to be received(strike out whichever is not applicable)

(1)

(2)

(3)

SCHEDULE XI

Sl.

No.

Name and address of person(s) responsible for paying fees for professional/technical services

Estimated amount of fees for professional/technical services to be received (strike out whichever is not applicable)

(1)

(2)

(3)

SCHEDULE XII

Sl.

No.

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

Estimated amount of compensation

or the enhanced compensation or

consideration or the enhanced

consideration

(1)

(2)

(3)

Date

Signature

Place

Address

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.

Full name and

address of

the seller

Date of sale with

reference

number of

such sale

Nature and

descripttion of

the goods sold

and details

of sale

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)

(2)

(3)

(4)

(5)

SCHEDULE II

Sl. No.	Full name and address of the person granting lease or licence	Date of grant of lease or licence or contract or transfer of right with reference number	Nature of contract or licence or lease and descripttion and details of the contract	Amounts expected to be debited/ paid in pursuance of the contract during the current financial year and each of the three immediately succeeding years.
(1)	(2)	(3)	(4)	(5)