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INTIMATION OF PAYMENT UNDER SUB-SECTION (1) OF SECTION 187 OF THE FINANCE ACT, 2016 IN RESPECT OF THE INCOME DECLARATION SCHEME, 2016

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..... ner/Commissioner Sir/Madam, 1. Pursuant to the acknowledgement received from you in Form-2 vide certificate F.No._________ dated _______, the detail of payments made are as under: A. Payments made on or before 30th day of November, 2016 Sl BSR Code of Bank Date of Deposit (DD/MM/YYYY) Serial Number of Challan* Amount (Rs) (1) (2) (3) (4) (5) **B. Payments made after 30th day of November, 2016 but .....

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..... S/TCS has not been claimed earlier. I further declare that I am furnishing the information in my capacity as (designation) of (name of the declarant) and I am competent to furnish the said information and verify it. Place: .. . Signature Date: .. .. Address of the declarant PAN of the declarant Note: **Strike off whichever is not applicable The form is to be furnished on or before the dates notifi .....

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