Statement of income from a country or specified territory outside India and Foreign Tax Credit

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..... Sl. No. Name of the country/ specified territory Source of income Income from outside India Tax paid outside India Tax payable on such income under normal provisions in India Tax payable on such income under section 115JB/ JC Credit claimed under section 90/90A Credit claimed under section 91 Amount Total foreign tax credit claimed Amount Rate Article No. of Double Taxation Avoidance Agreements .....

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..... ot being part of business income Fees for technical services not being part of business income Others (specify) Part-B 1. (a) Whether any refund of foreign tax has been claimed in any prior accounting year as a result of carry backward of losses Yes/ No (b) If reply to (a) above is Yes, f .....

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..... y stated. I further declare that I am making this statement in my capacity as ___________ and I am also competent to make this statement and verify it. Verified today the __________day of ___________20___. Place:______________ (Signature) Note: Attach certificate or statement and proof of payment/deduction of foreign tax as referred to in clause (ii) of sub-rule (8) of rule 128. ] ******* Notes 1. Inserted vide NOTIFICATION 54/2016 dated 27-06-2016 2. Substituted vide Notification No. 95/2019 dated 06-11-2019 .....

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