FORM No. 61A
[See rule 114E]
Annual Information Return under section 285BA of the Income -tax Act, 1961
(PART-A)

Please see the instructions and fill up relevant columns
1. Name of the person (in block letters)
(Please leave one blank box between two words.)
2. Permanent Account Number (PAN) of the person
(see instructions)
3. Folio Number of the person (see instructions)
4. Address (in block letters) (Please leave one blank box between two words.)
4.1 Flat No. 4.2 House/Premises No. 4.3 Floor No.
4.4 Building Name 4.5 Block/Sector
4.6 Road/Street 4.7 Locality/Colony
4.8 City 4.9 State Code (Refer to State Code in instructions)
4.10 Pin Code
5. Status (Individual-I, Company-C, Firm-F, Hindu undivided family-H, Government Office-G, Banks-B, Others-O)
6. Financial Year (transactions relating to which are reported) -
7. Address of Jurisdictional Director of Income-tax (Central Information Branch)
8. Total number of transactions reported in Annual Information Return (Part B)
9. Total value of all transactions reported in Annual Information Return (Part B) Rs.
10. Medium of Annual Information Return (Please strike off inapplicable)-CD/Floppy/DVD/ONLINE
Verification
I, (full name in block letters), son/daughter of solemnly declare that to the best of my knowledge and belief, the information given in Part A and Part B of
this return is correct and complete. I further declare that I am making this return in my capacity as and I am also competent to make this return and verify it. I further