FORM NO. 13
[See rules 28 and 37G]
Application by a person for a certificate under sections 197
and/or06C(9) of the Income-tax Act, 1961, for no deduction/collection of tax or
deduction/collection of tax at a lower rate
To
The Assessing Officer,
1. I, of do, hereby, request that a certificate may be issued to the person responsible for paying to me the incomes/sum by way of salary/interest on securities/interest other than "interest on securities"/insurance commission/commission (not being insurance commission) or brokerage/commission, etc., on the sale of lottery tickets/fees for professional or technical services/any sum by way of payment to contractors and sub-contractors/dividends/rent/income in respect of units/sum by way of payment of compensation on acquisition of immovable property (strike out whichever is not applicable) authorising him not to deduct income-tax/to deduct income-tax at the rate of per cent at the time of payment to me of such income/sum. The particulars of my income and other details are as per para 2.
and/or
I, of do, hereby, request that a certificate may be issued to the seller, being the person responsible for collecting the tax from me in respect of the amount payable by me as the buyer of [specify the nature of goods referred to in the Table in sub-section (1) of section 206C]/lessee or licensee of [specify the nature of contract or licence or lease referred to in the Table in sub-section (1C) of section 206C] (Strike out whichever is not applicable) authorizing him to collect 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.
2. The particulars of my income and other details are as under :
(i.) Status
(State whether individual, Hindu undivided family, firm, body of individuals, Company, etc.)
(ii.) Residential status
(Whether resident / resident but not ordinarily resident/non-resident)
(iii.) Permanent Account No. (PAN)
(iv.) Tax Deduction and Collection Account No. (TAN)
(v) Details of returns/statements which have become due but have not been filed :
Section under which return/statement has become due
Assessment year/ quarter
Due date for filing
Reason for not filing
(1)
(2)
(3)
(4)
Section 139
Section 200
Section 206C
(vi) Details of returned income/ assessed income for the last three assessment years:
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(enclose copies of returns of income filed alongwith their enclosures and copies of assessment orders, if assessed, for the last three assessment years.)
Assessment year
Total income as per return of income
Total income as per latest assessment
Total tax including interest payable on returned income
Total tax including interest payable on assessed income
(1)
(2)
(3)
(4)
(5)
(vii) Details of tax payment for the last three assessment years:
Assessment year
Total payment of tax including interest
Tax paid by way of Advance tax
Credit claimed for tax deduction at source
Credit claimed for tax collection at source
Tax paid by way of self assessment tax
Tax paid in response to notice of demand 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 income under the head "Profits and gains of business or profession": (enclose copies of profit and loss account and balance sheet along with audit report, if audited, for the last three previous years)
Gross profit
Net profit
Previous year
Gross sales, turnover receipt of business or profession
In rupees
In percentage to amount stated in column (1)
In rupees
In percentage to amount stated in column (1)
(1)
(2)
(3)
(4)
(5)
(6)
(ix) Details of existing liability under Income-tax Act, 1961 and Wealth-tax Act, 1957:
Assessment Year/ period
Liability under the Income-tax Act, 1961
Amount payable under
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Amount payable in respect of advance-tax
Amount payable for self- assessment tax
Amount for which notice of demand under section 156 has been served but not paid
Amount payable as deductor or collector which had become due but not paid.
the Wealth-tax Act, 1957
(1)
(2)
(3)
(4)
(5)
(6)
(x) Assessment year to which the payments relate
(xi) Estimated total income of the previous year relevant to the assessment year referred to in (x) above (give detailed computation and basis thereof)
(xii) Total tax including interest payable on the income at (xi)
(xiii) How the liability mentioned in col. (ix) and col. (xii) is proposed to be discharged?
(xiv) Details of payment of advance-tax and tax already deducted/collected for the assessment year relevant to the current previous year till date.
Nature of prepaid tax
Date of payment/deduction/collection
Advance tax
TDS
TCS
(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 or deduction of tax at a lower rate under section 197 and/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 wholly for charitable or religious purposes and that the income therefrom qualifies for exemption under sections 11 and 13 of the Income-tax Act, 1961.
I declare that the securities/sums/shares, particulars of which are given in the Schedules above, stand in my name and are beneficially owned by me, and the income therefrom is not includible in the total income of any other person under sections 60 to 64 of the Income-tax Act, 1961.
I further declare that what is stated in this application is correct.
Date_
Signature
Place
Address
Strike out whichever is not applicable.
ANNEXURE I
[For the purpose of tax deduction at source]
Please furnish the particulars with the Schedules below in respect of the payments for which the certificate is sought.
[ITR62;13,1] Printed
SCHEDULE I
Description of
securities
Number of
securities
Date of securities
Amount of securities
Estimated amount of
interest to be received
(1)
(2)
(3)
(4)
(5)
SCHEDULE II
Sl.
No.
Name and
address of
the person
to whom
the
sums are
given on
Interest
Amount
of
such sums
The date
on which
such
sums were
given on
interest
Period for
which
such
sums were
given on
Interest
Rate of
interest
Estimated
amount of
interest
to be
received
(1)
(2)
(3)
(4)
(5)
(6)
(7)
SCHEDULE III
Sl.
No
Name and address of person responsible for paying insurance commission
Estimated amount of insurance commission
(1)
(2)
(3)
SCHEDULE IV
Sl.
No.
Name and
address
of the
company
No. of
shares
Class of
shares and
face value
of each
share
Total face
value of
shares
Distinctive
numbers of
shares
Estimated amount
of dividend to be
received
(1)
(2)
(3)
(4)
(5)
(6)
(7)
SCHEDULE V
Sl
No.
Name and
address of the
Period of
employment
Amount of salary
Income from
house
Income from
sources other
Estimated total
[ITR62;13,1] Printed
employer
received
property
than salary and
income from
house property
income
(1)
(2)
(3)
(4)
(5)
(6)
(7)
SCHEDULE VI
Sl. No.
Name and address of person responsible for paying rent
Estimated amount of rent to be
received
(1)
(2)
(3)
SCHEDULE VII
Sl.
No.
Name and
Address
of the
mutual
fund
No. of
units
Classes of
units and
face value
of each
unit
Total face
value of
units
Distinctive
Numbers
of units
Estimated amount
of income to be
received
(1)
(2)
(3)
(4)
(5)
(6)
(7)
SCHEDULE VIII
Sl.
No.
Name and address of person responsible for paying commission (not being insurance commission referred to in section 194D) or brokerage.
Estimated amount of commission (not being insurance commission referred to in section 194D) or brokerage to be received
(1)
(2)
(3)
SCHEDULE IX
Sl. No.
Full name and address of the authority/person with whom the contract was made
Date of the contract
Nature of the contract
Date by which work on the contract would be completed
Sums expected to be credited/paid in pursuance of the contract during the current previous year and each of the three immediately succeeding
[ITR62;13,1]
years
(1)
(2)
(3)
(4)
(5)
(6)
SCHEDULE X
Sl.
No.
Name and address of person(s) responsible for paying commission, remuneration or prize (by whatever name called) on the sale of lottery tickets
Estimated amount of commission/remuneration/prize to be received(strike out whichever is not applicable)
(1)
(2)
(3)
SCHEDULE XI
Sl.
No.
Name and address of person(s) responsible for paying fees for professional/technical services
Estimated amount of fees for professional/technical services to be received (strike out whichever is not applicable)
(1)
(2)
(3)
SCHEDULE XII
Sl.
No.
Name and address of person responsible for
paying compensation or enhanced
compensation or the consideration or
enhanced consideration
on account of compulsory acquisition
of immovable property
Estimated amount of compensation
or the enhanced compensation or
consideration or the enhanced
consideration
(1)
(2)
(3)
Date
Signature
Place
Address
ANNEXURE II
[For the purpose of tax collection at source]
Please furnish particulars of the amounts payable in respect of which the certificate is sought in the schedules below:-
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SCHEDULE I
Sl.
No.
Full name and
address of
the seller
Date of sale with
reference
number of
such sale
Nature and
description of
the goods sold
and details
of sale
Amounts expected to be
debited/ paid in pursuance
of the sale during the
current financial year and
each of the three
immediately succeeding
years.
(1)
(2)
(3)
(4)
(5)
SCHEDULE II
Sl. No.
Full name and address of the person granting lease or licence
Date of grant of lease or licence or contract or transfer of right with reference number
Nature of contract or licence or lease and description and details of the contract
Amounts expected to be debited/ paid in pursuance of the contract during the current financial year and each of the three immediately succeeding years.
(1)
(2)
(3)
(4)
(5)
Date
Signature of the buyer
Full Name
Designation [ITR62;13,1]