Form 2 - Certificate of declaration under section 199C of the finance act,2016 in respect of the taxation and investment regime for Pradhan mantri garib yojana rules,2016 - Taxation and Investment Regime for Pradhan Mantri Garib Kalyan Yojana Rules, 2016

1 [Form 2 [ See rule 3 (4)] CERTIFICATE OF DECLARATION UNDER SECTION 199C OF THE FINANCE ACT, 2016, IN RESPECT OF THE TAXATION AND INVESTMENT REGIME FOR PRADHAN MANTRI GARIB KALYAN YOJANA RULES, 2016 Office of the Principal Commissioner/Commissioner of Income-tax, This is to acknowledge that a declaration under section 199C of the Finance Act, 2016 has been accepted in respect of the following: 1. Name and address of the declarant: . . . 2. Son/Daughter/Wife of . 3. PAN . 4. Receipt No. and date of filing the Declaration: . 5. Details of declaration as per Form-1 (a) Total amount of undisclosed income declared (b) Out of (a) above (i) Amount held in cash (ii) Details of amount deposited in a bank account/post office account etc. . . Sl. No. Account number Name of Bank/ Post office etc. Branch name IFSC code/ any other identity code Amount (in Rs.) Total (c) Tax, surcharge and penalty paid on the undisclosed income declared (d) Details of amount deposited in Pradhan Mantri Garib Kalyan Deposit Scheme, 2016 (i) Amount deposited (ii) Date of deposit (iii) Acknowledgement/deposit reference number (iv) Name and details of branch of the entity in which deposit is made Rs. ... .... Rs. ... ... . ... .... . ... .. .. . ... .... Date: .. (Pr. Commissioner/Commissioner of Income-tax) ] *********************** Notes:- 1. Inserted vide NOTIFICATION No. 116/2016 dated 16-12-2016