Certificate of donation under section 354(1)(g)

Part A: Particulars ofthe Donee

1.

Name:

(refer Note 1)

2.

Address:

(refer Note 2)

3.

Permanent Account Number (PAN):

4.

Unique Registration Number (URN):

5.

Date of Issue of URN:

6.

E-mail Id:

7.

Contact Number:

Country Code

Number

Part B: Details in respect of donors and donation

8.

Acknowledgement Number:

9.

Unique Identification Number (ID):

(refer Note 3)

10.

ID Code:

(refer Note 3)

11.

Name of Donor:

(refer Note 1)

12.

Address of Donor:

(refer Note 2)

13.

Amount of donation received:

14.

Financial year in which such donation was received:

15.

Type of donation:

(refer Note 4)

16.

Section under which donation is eligible for deduction:

Section 133(1)(b)(ii)

(refer note 5)

Verification

I, , holding PAN , solemnly affirm that to the best of my knowledge and belief, the information given in the certificate is correct and complete and is in accordance with the provisions of the Act. I further declare that I am making this certificate in my capacity (designation) and I am also competent to issue this certificate.

Type of Identification

ID Code

PAN

1

Type of Identification

ID Code

Passport number

2

Elector‘s photo identity number

3

Taxpayer Identification Number of the country

where the person resides

4

(I)

Corpus donation as per section 339

(II)

Voluntary contribution other than corpus donation

(III)

Specific grant

(IV)

Donation from Corporate Social Responsibility funds as referred to in section 135 of the Companies 2013 (18 of 2013)

(V)

Others, specify