FORM A - Application for approval of an electoral trust under the Electoral Trusts Scheme, 2013 - Electoral Trusts Scheme, 2013

1 [FORM A Application for approval of an electoral trust under the Electoral Trusts Scheme, 2013 To Member (Income-tax) Central Board of Direct Taxes New Delhi I, ______________________________ (Name), Designation ............................................... on behalf of _________________________ , being a company registered for the purposes of section 25 of the Companies Act, 1956 hereby apply for the approval of the said section 25 Company as an electoral trust under 1 [Electoral Trusts Scheme, 2013]. The following particulars are furnished herewith (1) Name and Address of the applicant in full [In BLOCK letters] : ____________ (2) Permanent Account Number : ____________ (3) Name and Address of the electoral trust in full [In BLOCK letters] : ____________ (4) Date of Registration as a Company for the purposes of Section 25 of the Companies Act, 1956 : ____________ (5) Name(s), address(es) and Permanent Account Number of members (including members of its Executive Committee, Governing Committee or Board of Directors) : ____________ (6) I also enclose the following documents : (a) An attested copy of the certificate evidencing registration of the company for the purposes of section 25 of the Companies Act, 1956; (b) certified copy of the articles of association and memorandum; (c) complete name, address and permanent account number of the shareholders; (d) initial share capital of the company and its source; (e) details of beneficiaries, if available; (f) details of contributors, if any; (g) an undertaking in the form of an affidavit stating that the receipts shall be distributed only to political parties registered under section 29A of the Representation of the People Act, 1951; and (h) copies of the accounts of the applicant for the last one/two/three years as applicable. Verification (a) The particulars given above and in the enclosed documents are true and correct. (b) The requirements contained in the rule 17CA of the Rules relating to the functioning of Electoral Trusts have been specifically included in the Articles of Association of the Company and shall be complied with. (c) I shall comply with all the provisions of the Scheme, the concerned rules and all the prescribed conditions subject to which approval, if any, shall be granted and have understood that in case of any failure to do so, the approval is liable to be withdrawn. (d) I undertake to communicate forthwith any alteration in the object and terms of the electoral trust or the shareholders or in any clause of the articles of association within thirty days of such change. Date :--------------- Signature _______________________ Designation ______________________ Address ___________________ ] -------------------------- Notes: 1. Corrected vide Notification No. 18/2013 (Income-Tax) dated 26/02/2013 , before it was read as, Electoral Trusts Scheme, 2012