BLANK IOCL Form 15G

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1. Substituted by IT (Fourteenth Arndt.) Rules 2015, w.e.f. 1-10-2015. Earlier Forrn No.

15G was
inserted by the IT (Fifth Arndt.) Rules, 1982, w.e.f. 21-6-1982 and later on arnended by the
IT (Fifth Arndt.) Rules, 1989, w.r.e.f. 1-4-1988, IT (Fourteenth Arndt.) Rules, 1990, w.e.f. 20-
11-1990 and IT (Twelfth Arndt.) Rules, 2002, w.e.f. 21-6-2002 and substituted by the IT
(Eighth Arndt.) Rules, 2003, w.e.f. 9-6-2003 and IT (Second Arndt.) 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.


l
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.
l0
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.
ll
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.
l2
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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