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Form of Declaration to be filed by a person who does not have either a
Permanent Account Number or General Index Register number and who makes
payment in cash in respect of transaction specified in clauses (a) to
(h) of rule 114B.
1. Full Name
and address of the declarant
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
2. Particulars of transaction
3. Amount of the transaction
4. Are you assessed to tax?
Yes/No
5. If yes,
(i) Details of Ward/Circle/Range where the last return of income was filed?
(ii) Reasons for not having Permanent Account Number/General Index Register
number?
6. Details of the document being produced in support of address in column(1)
.................................................................................................................................
Verification
I, .............................................................................
do hereby declare that what is stated
above is true to the best of my knowledge and belief.
Verified today, the……………………...day
of ………………………(Month), 200
.
Date…………………………
Place………………………..
Signature
of the declarant
nstructions:- Documents which can be produced in support of the address
are :-
(a)
Ration Card
(b)
Passport
(c)
Driving Licence
(d)
Identity Card issued by any institution
(e)
Copy of the electricity bill or telephone bill showing residential address
(f)
Any document or communication issued by any authority of Central Government,
State Government or local bodies showing residential address
(g)
Any other documentary evidence in support of his address given in the
declaration
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