Form for furnishing accountant certificate under first proviso to sub-section (6A) of section 206C of the Income-tax Act, 1961

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..... at (address of the seller/licensor/lessor) _______________ I do hereby state that I, being the person responsible for collecting tax had received from debited to the account of (name of the buyer/licensee/lessee) _________________ a sum of _______________ rupees without collection of whole or any part of tax. A certificate from accountant certifying that the buyer/licensee/lessee has fulfilled all the conditions mentioned in the first proviso to sub-section (6A) of section 206C of the Income-tax Act, 1961 is enclosed as Annex 'A' to this Form. I, further, state that the interest under sub-section (7) of section 206C amounting to ____________ rupees for non-collection short collection of tax * has been paid by me, the de .....

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..... part of the tax in accordance with the provisions of Chapter -XVII-BB Nature of Receipt Date of Receipt or debit Section under which tax was Collectible Amount received or debited Amount tax collectible Details of amount collected, if any Amount collected Date of collection ( ii ) The buyer/licensee/lessee, has furnished h .....

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..... ( iv ) It has been ensured that the information furnished is true and correct in all respects and no relevant information has been concealed or withheld ( v ) Neither I, nor any of my partners, is a director, partner or an employee of the above mentioned entities or its associated concerns I/we* fully understand that any statement made in this certificate, if proved incorrect or false, will render me/us* liable for any penal or other consequences as may be prescribed in law or is otherwise warranted. (Signature and Stamp/Seal of the Signatory) Accountant Place: Name of the Signatory.............................. Date: .....

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