ACKNOWLEDGEMENT OF DECLARATION UNDER SECTION 183 OF THE FINANCE ACT, 2016 IN RESPECT OF THE INCOME DECLARATION SCHEME, 2016

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..... .......... (hereinafter referred to as the declarant) has filed a declaration under section 183 of the Finance Act, 2016; And whereas the said declaration has been received on ............................. ; Now, therefore after consideration of relevant material, I hereby determine the following amount payable by you with respect to the declaration made under the scheme: Sl. No. Assessment year U .....

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..... ove, the declaration under Form-1 shall be treated as void and shall be deemed never to have been made. ] ................................................ Name, signature and seal of Designated Authority Place ................... Date ..................... ] ***************** NOTES:- 1. Inserted vide NOTIFICATION NO. 33/2016 dated 19-05-2016 2. Substituted vide NOTIFICATION 70/2016 dated 12-08-201 .....

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