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Free Form 15G Income Tax India Form - PDF Form Download

Form 15G Income Tax India Form Overall rating: ☆☆☆☆☆ 0 based on 0 reviews
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Form 15G is a form which can help a person avoid TDS incase one does not have to pay income tax at the end of the year.



Form 15G Income Tax India Form

Text Version of this form

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FORM NO. 15G
[ See rule 29C]

Declaration under sub-sections (1) and (1A) of section 197A of the
Income-tax Act, 1961, to be made by an individual
or a person (not being a company or a firm) claiming
certain receipts without deduction of tax
I/We* __________________________________________________
*son/daughter/wife of
_______________________________________________resident of
_________________________ @ do hereby declare—
1. *that I am a shareholder in
________________________________________________________
(name and address of the company) and the shares in the said
company, particulars of which are given in Schedule I below, stand in
my name and are beneficially owned by me, and the dividends
therefrom are not includible in the total income of any other person
under sections 60 to 64 of the Income-tax Act, 1961;
Or
*#that the securities or sums, particulars of which are given in
Schedule II or Schedule III or Schedule IV below, stand in *my/our
name and beneficially belong to *me/us, and the *interest in respect
of such securities or sums and/or income in respect of units is/are not
includible in the total income of any other person under sections 60 to
64 of the Income-tax Act, 1961;
Or
*that the particulars of my account under the National Savings
Scheme and the amount of withdrawal are as per the Schedule V
below;
2. that *my/our present occupation is;
3. that the tax on *my/our estimated total income, including—
*the dividends from shares referred to in Schedule I below;
and/or
*#interest on securities, interest other than “interest on
securities” and/or income in respect of units, referred to in
Schedule II, Schedule III and/or Schedule IV below;
and/or
*the amount referred to in clause (a) of sub-section (2) of section
80CCA, mentioned in Schedule V below,
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;
4. that *my/our income from *dividend/interest on securities/interest
other than “interest on securities”/units/amounts referred to in clause
(a) of sub-section (2) of section 80CCA or the aggregate of such
incomes, computed in accordance with the provisions of the Income-

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tax Act, 1961, for the previous year ending on ________ relevant to
the assessment year 20____-20____ will not exceed the maximum
amount which is not chargeable to income-tax;
5. that *I/we have not been assessed to income-tax at any time in the
past but I fall within the jurisdiction of the Chief Commissioner or
Commissioner of Income-tax ___________;
Or
that *I was/we were last assessed to income-tax for the assessment
year______________—____________by the Assessing Officer
Circle/Ward/District and the permanent account number allotted to
me is ____________ ;
6. that I *am/am not resident in India within the meaning of section 6
of the Income-tax Act, 1961;
7. Particulars of the *shares of the company/securities/sums/account
under the National Savings Scheme and the amount of withdrawal
referred to in paragraph 1 above, in respect of which the declaration is
being made, are as under:

SCHEDULE I

No. of Class of shares and Total face Distinctive Date(s) on which the
shares face value of each value of numbers of the shares were acquired by
share shares shares the declarant

SCHEDULE II

Description of Number Date(s) of Amount of Date(s) on which the
securities of securities securities securities were acquired
securities by the declarant

SCHEDULE III

Name and address of Amount of Date on which Period for which Rate of
the person to whom the such sums sums were given such sums were interest
sums are given on on interest given on interest
interest

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SCHEDULE IV

Name and address of the Number of Class of units and face Distinctive Income in
Mutual Fund units value of each unit number of respect of
units units

SCHEDULE V

Particulars of the Post Office where the Date on which the The amount of
account under the National Savings account was opened withdrawal from the
Scheme is maintained and the account account
number

**Signature of the declarant

Verification

*I/We
__________________________________________________ do
hereby declare that to the best of *my/our knowledge and belief
what is stated above is correct, complete and is truly stated.
Verified today, the _____________ day of
Place __________ _________________________
Signature of the declarant
Notes:
1.@ Give complete postal address.
2. The declaration should be furnished in duplicate.
3. *Delete whichever is not applicable.

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4. #Declaration in respect of these payments can be furnished by a
person (not being a company or a firm).
5. **Indicate the capacity in which the declaration is furnished on behalf
of a Hindu undivided family, association of persons, etc.
6. Before signing the verification, the declarant should satisfy himself
that the information furnished in the declaration 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 one 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 three years and
with fine.

PART II
[FOR USE BY THE PERSON TO WHOM THE DECLARATION
IS FURNISHED]

1. Name and address of the person
responsible for paying the income,
mentioned in paragraph 1 of the
declaration
2. Date on which the declaration was
furnished by the declarant
3. Date of *declaration, distribution or
payment of dividend/withdrawal from
account number ____________ under
the National Savings Scheme
4. Period in respect of which *dividend
has been declared/interest is being
credited or paid/income in respect of
units is being credited or paid
5. Amount of *dividend/interest or
income in respect of units/withdrawal
from National Savings Scheme Account
6. *Rate at which interest or income in
respect of units, as the case may be, is
credited/paid
Forwarded to the Chief Commissioner or Commissioner of Income-tax
Place ___________ ___________________________________
Date ____________ Signature of the person respon-
sible for paying the income re-
ferred to in Paragraph 1

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