Excess tds deposit refund application

Format for Indemnity Bond (to be typed on non judicial Stamp Paper of Rs. 100) :::

INDEMNITY BOND

This Bond of indemnity is made this _________ (Date of Indemnity Bond) in favour of  Government of India (Department of Finance) i.e. Income Tax Department by Mr./Mrs./Ms. _____________________ (Name of the Indemnifier)   Son of/Daughter of/Wife of __________________________ on behalf of self or M/s _______________________

PAN _________    

Status__________

WHEREAS This is to undertake:

1. That I had filed my Income Tax Return for the Assessment Year ________

2. That TDS claimed in the return of Rs. __________ belongs to me as per TDS certificates mentioned below

Name of Deductor, TAN of deductor, Date of TDS certificate, Amount

a. ______________________

b. ______________________

OR

That Challan(s) paid for Rs. ______________ belongs to me as given below:

Date of Payment, Bank through which payment made, Amount

a. ______________________

b. ______________________

3. That in case it is found that the TDS certificates/Challan does not belong to me then the executor of this bond indemnify the Government of India (Ministry of Finance) for the loss, claim and excess amount of refund, if any, in all respect.

The executor of this bond indemnifies the government of India (Ministry of Finance) and keep it indemnified against all costs, damages, charges and expenses, excess amount of refund, interest, reduction in demand and also against all sum/money, whether for damages, costs, charges, expenses or otherwise.

In witness where of this bond is executed today this ____________ (Date).

(……………………..)

……………………………

Refer:: cbdt-instruction-4/2014-dated-april-7-2014