Professional Documents
Culture Documents
Form No.13
[See rules 28 and 37G]
Application by a person for a certificate under sections 197
and/or 206C(9) of the Income-tax Act, 1961, for no
*deduction/collection of tax or *deduction/
collection of tax at a lower rate
To
and/or
*I, of do, hereby, request th at a certificate m ay be issued to th e seller, being the person responsible
for collecting the tax from m e in respect of the amount payable by m e as the buyer of [specify the
nature of goods referred to in th e T able in sub-section (1) of section 206C] /lessee or licensee of
[specify the natu re of contract o r licence o r leas e r eferred to in the Ta ble in sub -section (1C) of
section 206C] (Strike out whichever is not applicable) auth orizing him to collec t income-tax at the
rate of per cent at the time of debit of such amount to my account or receipt thereof from me, as the
case may be. The particulars of my income and other details are as per para 2.
(i) Status
(v) Details of returns/statements which have become due but have not been filed :
Section under which Assessment Due date for filing Reason for not filing
return/statement has year/ quarter
become due
(1) (2) (3) (4)
Section 139
Section 200
Section 206C
(vi) Details of returned income/ assessed income for the last three assessment years:
(enclose copies of returns of incom e f iled alongwith their enclos ures and copies of
assessment orders, if assessed, for the last three assessment years.)
Assessment Total inco me as Total income as Total tax including Total tax including
year per retu rn of per latest interest payable on interest payable on
income assessment returned income assessed income
(1) (2) (3) (4) (5)
(vii) Details of tax payment for the last three assessment years:
Assessment Total Tax paid Credit Credit Tax paid Tax paid in
year payment by way of claimed for claimed for by way of response to
of tax Advance tax tax collection self notice of
including tax deduction at source assessment demand
interest at source tax under
section 156
(1) (2) (3) (4) (5) (6) (7)
(viii) Details of sales, profit, etc. for the last three previous years in the case of assessee whose
income include incom e under the head "Pro fits and gains of business or profession":
(ix) Details of existing liability under Income-tax Act, 1961 and Wealth-tax Act, 1957:
Liability under the Income-tax Act, 1961
Amount Amount Amount for Amount Amount
Assessment payable in payable for which notice of payable as payable
Year/ period respect of self- demand under deductor or under the
advance-tax assessment section 156 has collector which Wealth-tax
tax been served but had become due Act, 1957
not paid but not paid
(1) (2) (3) (4) (5) (6)
(xv) Details of income claimed to be exempt and not included in the total income in col.
(xi) (Please append a note giving reason for claiming such exemption).
(xvi) Please furnish the particulars in Annexure- I in respect of no deduction of tax under
section 197 where it is requested that certifi cate is to be issued under sub-rule (4) of
rule 28AA; or in Annexure –I-A in respect of deduction of tax at a lower rate under
section 197 where it is requested that the certificate is to be issued under sub-rule (6) of
rule 28AAand/or in Annexure-II for collection of tax at lower rate under section 206C(9) of the
Income-tax Act, as the case may be.
*I, _____________ the trustee/co-trustee of ________________ do hereby declare that the
securities/sums/shares, particulars of which are given in the Annexure, are properly held under trust
ANNEXURE I
[For the purpose of tax deduction at source]
Please furnish the particulars in th e Schedules be low in respect of th e paym ents f or which the
certificate is sought, —
SCHEDULE I
SCHEDULE II
Sl. Name and Amount of The date Period for which Rate of Estimated amount
No. address of the such sums on which such sums were interest ofinterest to
person to such sums given on Interest be received
whom thesum s were given
are given on
on Interest interest
SCHEDULE III
SCHEDULE IV
SCHEDULE V
SCHEDULE VI
Sl. Name and address of person responsible for Estimated amount of rent to be
No. paying rent received
SCHEDULE VII
Sl. Name and No. of Classes of Total face Distinctive Estimated amount
SCHEDULE VIII
Sl. Name and address of person responsible for Estimated amount of comm ission (not
No. paying commission (not being insurance being insurance comm ission referred to
commission referred to in section194D) or in section194D) or brokerage to be
brokerage. received
SCHEDULE IX
Sl. Full nam e and Date of Nature of Date by which Sums expected to be
No. address of the the the contract work on the credited / paid in
authority/person contract contract would pursuance of the contract
with whom the be completed during the current
contract previous year and each of
was made the three immediately
succeeding years
SCHEDULE X
SCHEDULE XII
Sl. Name and address of person responsible for Estimated amount of com pensation
No. paying compensation or enhanced compensation or the enhanced compensation
or the consideration or enhanced consideration or consideration or the enhanced
on account of compulsory acquisition of consideration
immovable property
………………………..
(Signature)
Date……………
………………………..
Place ………………. ………………………..
………………………..
(Address)
ANNEXURE I-A
[For the purpose of tax deduction at source]
Please furnish the particulars in th e Schedule below in respect of the paym ents for which th e
certificate is sought, —
SCHEDULE
………………………..
(Signature)
Date……………
………………………..
Place ………………. ………………………..
………………………..
(Address)
Please furnish particulars of the am ounts payable in respect of whic h the certificate is sought in the
schedules below:-
SCHEDULE I
Sl.No. Full name and Date of sale Nature and Amounts expected to be
address of the seller with reference description of debited/ paid in pursuance
number of the goods sold of the sale during the
such sale and details current financial year and
of sale each of the three
immediately succeeding
years
SCHEDULE II
Sl. Full name and Date of grant of Nature of contract Amounts expected to be
No. address of the leaseor licence orlicence or lease debited/ paid in pursuance
person granting or contractor anddescription of the contract during the
lease or licence transfer of right and details ofthe current financial year and
with reference contract each of the three
number immediately succeeding
years
Date …………
…………………………………
Signature of the buyer
Full Name……………………...
Designation ………………….