Statement of accumulation or setting apart of income under section 342(1)

Part A: Particulars ofthe Applicant

1.

Name:

(refer Note 1)

2.

Address:

(refer Note 2)

3.

Permanent Account Number (PAN):

4.

E-mail Id:

5.

Contact Number:

Country

Code

Country

Code

6.

Tax Year:

Part B: Details of Accumulation

7.

Accumulation for the tax year:

Sl.

No.

Purpose for

which amount is

being

accumulated

Amount of

accumulation

Period of Accumulation

Date of resolution passed by

Trustee/Governing Body/

Managing Committee

Starting

tax year

Ending

tax year

8.

Status of Accumulation for preceding tax years:

Sl.

No.

Tax

Year of

accumu

lation

(refer

Note 3)

Date of

filing Form

No. 109

Amount

accumulate

d

Tax Year

upto which

accumulated

Amount

applied up to

the end of

the current

tax year

Amount

remaining

for

application

Amount of

accumulation

treated as specified income as per section 337 (Table: Sl. No. 8)

1.

2.

(Repeat

, if

require

d)

9.

Non-application of accumulated income due to order or injunction of any court:

Sl.

No.

Tax year of accumulation

Amount of

accumulation

Tax Year(s) of non- application

Details oforder or

injunction by the Court

1.

2.

(Repeat, if required)