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Declaration under section 197A(1C) of the Income-tax Act, 1961 to be made by an individual who is of the age of sixty years or more claiming certain receipts without deduction of tax.

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..... ion is being made) 5. Flat/Door/Block No. 6. Name of Premises 7. Road/Street/Lane 8. Area/Locality 9. Town/City/District 10. State 11. PIN 12. Email 13. Telephone No. (with STD Code) and Mobile No. 14 (a) Whether assessed to tax 4 : Yes No (b) If yes, latest assessment year for which assessed .....

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..... uly stated and 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 further declare that the tax on my estimated total income including *income/incomes referred to in column 15 *and aggregate amount of *income/incomes referred to in column 17 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. Place: ...................................... Date: ....................................... ................................................................ Signature .....

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..... or Aadhaar Number ] . 2. Declaration can be furnished by a resident individual who is of the age of 60 years or more at any time during the previous year. 3. The financial year to which the income pertains. 4. 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. 5. 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. 6. In case any declaration(s) in Form No. 15H is filed before filing this declaration during the previous year, mention the total number of such Form .....

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..... 10. The person responsible for paying the income referred to in column 15 of Part I shall not accept the declaration where the amount of income of the nature referred to in section 197A(1C) 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 after allowing for deduction(s) under Chapter VI-A, if any, or set off of loss, if any, under the head income from house property for which the declarant is eligible. 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 15 and 17. ] .....

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