FORM DAA INTIMATION TO THE ASSESSING OFFICER OF HAVING MADE AN
APPLICATION TO THE SETTLEMENT COMMISSION
(See Section 22C of the Wealth-tax Act, 1957 and rule 4A of the Wealth-tax Rules, 1957)

For Office use only
Receipt No.
.......................
Date
...............
FORM DAA INTIMATION TO THE ASSESSING OFFICER
OF HAVING MADE AN APPLICATION TO THE
SETTLEMENT COMMISSION
(See Section 22C of the Wealth-tax Act, 1957
and rule 4A of the Wealth-tax Rules, 1957) Seal and Signature of
Receiving Official
Name PAN
Flat/Door/Block No. Name of Premises/ Building/Village Status (Tick)

(i) Individual
Road/Street/Post
Office
Area/Locality (ii) Hindu undivided family
State Pin Code (iii) Company
Town/City/District
E-mail Address
PART-A
PERSONAL
INFORMATION
STD code and Phone
Number ( )
1. Designation of Assessing Officer (Ward/Circle)
2. The Commissioner having jurisdiction over the applicant
3. Assessment year(s) in connection with which the application for settlement is made and the
date of filing the return
PART-B
ASSESSMENT
JURISDICTION
AND FILING
STATUS
CERTIFICATE
I, ....................................................................., son/daughter/wife of ................................................................... do hereby
certify that I have made today an application in Form DA under sub-section (1) of section 22C of the Wealth-tax Act with
above-mentioned particulars to the Settlement Commission at ..................Bench by post/by hand (delete whichever is not
applicable) vide Receipt No...........................(write receipt No. in case the application has been made by hand) in my
capacity as ........................[write your designation]
Place Date Signature of applicant
Seal and Signature of Receiving Official
Name PAN
Flat/Door/Block No. Name of Premises/ Building/Village Status (Tick)

(i) Individual
Road/Street/Post
Office
Area/Locality (ii) Hindu undivided family
State Pin Code (iii) Company
Town/City/District
E-mail Address
PART-A
PERSONAL
INFORMATION
STD code and Phone
Number ( )
1. Designation of Assessing Officer (Ward/Circle)
2. The Commissioner having jurisdiction over the applicant
3. Assessment year(s) in connection with which the application for settlement is made and the date of filing the return
PART-B
ASSESSMENT
JURISDICTION
AND FILING
STATUS
CERTIFICATE
I, ....................................................................., son/daughter/wife of ................................................................... do hereby certify that I have made today an application in Form DA under sub-section (1) of section 22C of the Wealth-tax Act with above-mentioned particulars to the Settlement Commission at ..................Bench by post/by hand (delete whichever is not applicable) vide Receipt No...........................(write receipt No. in case the application has been made by hand) in my capacity as ........................[write your designation]
Place
Date Signature of applicant