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CERTIFICATE #pdf
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W e hereby certify the following: A B 1.CountryCurrency 2. In foreign currency In Indian Rs. 3. Name of the Bank Branch of the bank 4. 8 5. (dd/mm/yyyy) 6. 7. (Tick) 8. (Tick) Nature of remittance as per agreement/document In case the remittance is net of taxes, whether tax payable has been grossed up? (iii) if yes, (ii) if not reason thereof Form No. 15CB (See Rule 37BB) Certificate of an accountant we have examined the agreement between M/s …......………………. (R emitters) and M/s …….....………………………………………. (Beneficiary) requiring the above remittance a s well as the relevant documents and books of account required for ascertaining the nature of remittance and for determining the rate of deduction of tax at source as per provisions of Chapter -XVII-B BSR Code of the bank branch (7 digit) Proposed date of remittance Country to which remittance is made Amount Payable Name and address of the beneficiary of the remittance Taxability under th provisions of the Income Tax Act (without considering DTAA) (i) is remittance chargeable to tax in India (a) the relevant section of the Act under which YesNo YesNo YesNo YesNo YesNo YesNo YesNo 9. In Indian Rs. In Indian Rs. (a) whether such income is liable to tax in India (Tick) (c) if not, please furnish brief reasons thereof, specifying relevant articles of DTAA - C. In case the remittance is on account of capital gains; please indicate (Tick) (b) Rate of TDS required to be deducted in terms of such article of the applicable DTAA B. In case of remittance is on account of business income; please indicate (Tick) (b) if so, the basis of arriving at the rate of deduction of tax -As per DTAA (%) (iii) taxable income as per DTAA (iv) tax liability as per DTAA A. If the remittance is for royaties, fee for technical services, interest, dividend etc. (not connected with permanent establishment) please indicate:- (Tick) (a) Article of DTAA (ii) please specify relevant DTAA Nature of payment as per DTAA - (ii) please specify relevant article of DTAA (c) the tax liability If the income is chargeable to tax in India and any relief is claimed under DTAA (i) whether tax residency certificate is obtained from the recipient of remittance (Tick) (d) basis of determining taxable income and tax liability (a) the relevant section of the Act under which the remittance is covered (b) the amount of income chargeable to tax YesNo YesNo YesNo YesNo YesNo YesNo YesNo (a) amount of long term capital gains YesNo YesNo YesNo YesNo YesNo YesNo YesNo 10.In Indian Rs. 11. or 12. 13. Signature:Name: Name of the proprietorship/firm: Address: Registration No: Date of deduction of tax at source, if any (dd/mm/yyyy) Actual amount of remittance after TDS In foreign currency Rate of TDS As per Income tax Act % As per DTAA % (c) If yes, rate of TDS required to be deducted in terms of such article of the applicable DTAA (d) If not, the please furnish brief reasons thereof specifying relevant article of DTAA In foreign currency Amount of TDS D. In case of other remittance not covered by sub-items A,B and C (Tick) (a) Please specify nature of remittance (b) W hether taxable in India as per DTAA (b) amount of short term capital gains (c) basis of arriving at taxable income Certificate No. YesNoYesNo




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