Application under sub-section (20) of section 155 for credit of tax deduction at source (TDS)

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..... on : (3) Name of the person in respect of which the application is being furnished (if different from (1)) (See note 1) : (4) PAN of the person in respect of which the application is being furnished (if different from (2)) (See note 1) : (5) Whether the deductee is resident or non-resident? : (6a) Address of the person furnishing the application : (6b) PIN/ Zip Code of the person fu .....

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..... Amount of tax deducted on specified income in subsequent financial year (See Note 4) Date of deduction of tax (dd/mm/ yyyy) (1) (2) (3) (4) (5) (6) (7) .....

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..... (12) (13) (14) Total .....

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..... claimed credit for the tax deducted at source on the specified income claimed in Form No. 71 in any other assessment year and will not claim the same. d) I also declare that I am making application in my capacity as . of and I am also competent to make this application and verify it. Date: Signature: Place: Address: Note: 1. Information in Row no. (3) and ( .....

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