103120000000007845

INCOME-TAX RULES, 1962
FORM NO. 15G 1
See section 197A(1), 197A(1A) and rule 29C]

[
Declaration under section 197A(1) and section 197A(1A) to be made by an

individual or a person (not being a company or firm) claiming certain
incomes without deduction of tax
PART I
1. Name of Assessee (Declarant) 2. PAN of the Assessee1
3. Status2 4. Previous year(P.Y.)3 5. Residential Status4
(for which declaration is being made)
6. Flat/Door/Block No. 7. Name of Premises 8. Road/Street/Lane 9. Area/Locality
10. Town/City/District 11. State 12. PIN 13. Email
14. Telephone No. (with STD 15 (a) Whether assessed to tax under the Yes No
Code) and Mobile No. Income-tax Act, 19615:
(b) If yes, latest assessment year for which assessed
16. Estimated income for which this declaration 17. Estimated total income of the P.Y. in which
is made income mentioned in column 16 to be included6
18. Details of Form No. 15G other than this form filed during the previous year, if any7
Total No. of Form No. 15G filed Aggregate amount of income for which Form No.15G filed
19. Details of income for which the declaration is filed

Sl. Identification number of relevant Nature of income Section under which tax Amount of income
No. investment/account, etc.8 is deductible
...............................................................
Signature of the Declarant 9

Declaration/Verification 10
*I/We............................................................... do hereby declare that to the best of *my/our knowl-

edge and belief what is stated above is correct, complete and is truly stated. *I/We declare 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/We further declare that the tax *on
my/our estimated total income including *income/incomes referred to in column 16 *and
aggregate amount of *income/incomes referred to in column 18 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. *I/We also declare that *my/our
*income/incomes referred to in column 16 *and the aggregate amount of *income/incomes
referred to in column 18 for the previous year ending on .............................. relevant to the
assessment year .............................. will not exceed the maximum amount which is not charge-
able to income-tax.
Place: ........................................ ...............................................................

Date: ........................................ Signature of the Declarant 9
1. Substituted by IT (Fourteenth Amdt.) Rules 2015, w.e.f. 1-10-2015. Earlier Form No. 15G was
inserted by the IT (Fifth Amdt.) Rules, 1982, w.e.f. 21-6-1982 and later on amended by the
IT (Fifth Amdt.) Rules, 1989, w.r.e.f. 1-4-1988, IT (Fourteenth Amdt.) Rules, 1990, w.e.f.
20-11-1990 and IT (Twelfth Amdt.) Rules, 2002, w.e.f. 21-6-2002 and substituted by the IT
(Eighth Amdt.) Rules, 2003, w.e.f. 9-6-2003 and IT (Second Amdt.) Rules, 2013, w.e.f. 19-2-2013.
PART II
[To be filled by the person responsible for paying the income
referred to in column 16 of Part I]
1. Name of the person responsible for paying 2. Unique Identification No.11
3. PAN of the person 4. Complete Address 5. TAN of the person responsible for paying
responsible for paying
6. Email 7. Telephone No. (with STD Code) and Mobile No. 8. Amount of income paid12
9. Date on which Declaration is received 10. Date on which the income has been paid/credited
(DD/MM/YYYY) (DD/MM/YYYY)
Place: .......................................... .................................................................................................

Date: .......................................... Signature of the person responsible for paying
the income referred to in column 16 of Part I
*Delete whichever is not applicable.

1
As per provisions of section 206AA(2), the declaration under section 197A(1) or 197A(1A) shall
be invalid if the declarant fails to furnish his valid Permanent Account Number (PAN).
2
Declaration can be furnished by an individual under section 197A(1) and a person (other than
a company or a firm) under section 197A(1A).
3
The financial year to which the income pertains.
4
Please mention the residential status as per the provisions of section 6 of the Income-tax Act,
1961.
5
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.
6
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.
7
In case any declaration(s) in Form No. 15G is filed before filing this declaration during the
previous year, mention the total number of such Form No. 15G filed along with the aggregate
amount of income for which said declaration(s) have been filed.
8
Mention the distinctive number of shares, account number of term deposit, recurring
deposit, National Savings Schemes, life insurance policy number, employee code, etc.
9
Indicate the capacity in which the declaration is furnished on behalf of a HUF, AOP, etc.
10
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.
11
The person responsible for paying the income referred to in column 16 of Part I shall allot
a unique identification number to all the Form No. 15G 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.15H during the same quarter, please
allot separate series of serial number for Form No.15G and Form No.15H.
12
The person responsible for paying the income referred to in column 16 of Part I shall not
accept the declaration where the amount of income of the nature referred to in sub-section
(1) or sub-section (1A) of section 197A 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. 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 16 and 18.

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INCOME-TAX RULES, 1962

FORM NO. 15G 1

See section 197A(1), 197A(1A) and rule 29C]

Declaration under section 197A(1) and section 197A(1A) to be made by an

19. Details of income for which the declaration is filed

Signature of the Declarant 9

I/We............................................................... do hereby declare that to the best of my/our knowl-

Place: ........................................ ...............................................................

Place: .......................................... .................................................................................................

*Delete whichever is not applicable.

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