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Form of declaration under section 203 of the Finance Act, 2016 in respect of the Direct Tax Dispute Resolution Scheme, 2016

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..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-mail . . . . . . . . . . . . . . . . . . . . Telephone No. . . . . . . . . . . . . . . . . . . . Residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-mail . . . . . . . . . . . . . . . . . . . . Telephone No. . . . . . . . . . . . . . . . . . . . . 3. Permanent account number (PAN) . . . . . . . . . . . . . . . . . . 4. Status of the declarant (a) State whether individual, HUF, firm, company etc. . . . . . . . . . . . . . . . . . . . .....

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..... claration under section 202 . . . . . . . . . . . . . . . . . . . . . . . . . . . (f) Amount payable under section 202(I)(a) : . . . . . . . . . . . . . . . . . . . . . . . . . . . (i) Amount as per (e) above . . . . . . . . . . . . . . . . . . . . . . . . . . . (ii) 25% of minimum penalty leviable if (d)(i) is of Rs.10 lakh or more . . . . . . . . . . . . . . . . . . . . . . . . . . . (iii) Total (i) + (ii) . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. In case the appeal relates to penalty order : (a) Assessed total income or net wealth for the assessment year in respect of which penalty has been levied . . . . . . . . . . . . . . . . . . . . . . . . . . . (b) Tax and interest determined on total income . . . . . . . . . . . . . .....

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..... ing declaration under section 202 . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Amount payable under section 202(II) [4(i) 5] . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. Details of pendency as on 29-2-2016, of appeal/ writ filed or proceedings for arbitration/ conciliation/mediation initiated or notice given : . . . . . . . . . . . . . . . . . . . . . . . . . . . (i) Authority or court . . . . . . . . . . . . . . . . . . . . . . . . . . . (ii) (a) Appeal/writ petition number . . . . . . . . . . . . . . . . . . . . . . . . . . . (b) Arbitration/Conciliation/Mediation reference number . . . . . . . . . . . . . . . . . . . . . . . . . . . (iii) Date of filing/date on which notice given . . . . . . . . . . . . . . . . . .....

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..... referred to in section 201(1)(b) of the Finance Act, 2016. 2. More sheets may be used wherever necessary to give complete details. 3. Attach necessary details in respect of payment of tax, interest or penalty made on or before the date of filing of this declaration. 4. In case the declaration relates to specified tax, the form should be accompanied with an undertaking in Form-2. 4. Strike off the row/part which is not applicable. 5. No column should be left blank. Wherever the entry is not relevant the column should be filled in as 'Not Applicable'. 6. Any other relevant information may be briefly indicated in a separate sheet, if required. - Forms Tax Management India - taxmanagementindia - taxmanagement - taxmanagementindia.co .....

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