2024 07 1 13 10 18 15GH - Acknowledge
2024 07 1 13 10 18 15GH - Acknowledge
2024 07 1 13 10 18 15GH - Acknowledge
15G
[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) : KAJAL A SAMANI 2. PAN of the Assesee1 : BSDPS9708P
3. Status2 : Individual 4. Previous year(P.Y.)3(for which declaration is being made): 5. Residential Status4 : Resident
2023 - 2024
14. Telephone No. (with STD Code) and Mobile No. : 15 (a) Whether assessed to tax under the Income-tax Act, Yes No
9004901931
19615 :
(b) If yes, latest assessment year for which assessed: 2023-24
16. Estimated income for which this declaration is made : 290.00 17. Estimated total income of the P.Y. in which income mentioned in column
16 to be included6 : 290.00
Total No. of Form No. 15G filed Aggregate amount of income for which Form No.15G filed
1 290.00
Sl. Identification number of relevant Nature of income Section under which tax is deductible Amount of income
No. investment/account, etc.8
*I/We, KAJAL A SAMANI do hereby declare that to the best of *my/our knowledge 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 31st March, 2024 relevant to the
assessment year 2024 - 2025 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 31st March, 2024 relevant to the assessment year 2024 - 2025 will not exceed the maximum amount which
is not chargeable to income-tax.
Place:....................
1. Name of the person responsible for paying : ICICI Bank Limited 2. Unique Identification No.11 :
3. PAN of the person 4. Complete Address : ICICI Bank Towers, Bandra-Kurla 5. TAN of the person responsible
responsible for paying : AAACI1195H Complex, Mumbai - 400 051 for paying :
9. Date on which Declaration is received 10. Date on which the income has been paid/credited
(DD/MM/YYYY) : 07/01/2024 (DD/MM/YYYY) :
Place:.....................
Date:......................... ..............................................................................
Signature of the person responsible for paying
the income referred to in Column 16 of Part I