Statement of income distributed by a business trust to be provided to the unit holder under section 115UA of the Income-tax Act, 1961

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..... nit holder 3. 3 [ Permanent Account Number or Aadhaar Number ] of the unit holder 4. Previous year ending 5. Name and address of the business trust 6. 3 [ Permanent Account Number or Aadhaar Number ] of the business trust 2 [7. Details of the income distributed by the business trust to the unit holder, during the previous year, in the following format:- .....

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..... in the Annexure(s), including the documents accompanying such Annexure(s), is correct and complete. I further declare that I am furnishing such statement in my capacity as ___________________ (designation) and that I am competent to furnish this statement and verify it. Verified today the day of _. Place - Signature____ ---------------------------- Notes: 1. Inserted vide No .....

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