Application by a person specified in rule 209 for a certificate under section 395(1), for receipt of certain sums without deduction of tax

Part B (to be filled where applicant is banking company/insurer)

Declaration and Request

I, … . (name of declarant) having Permanent Account Number … .. being the principal officer of … … .. (name of the applicant), hereby declare:

1. That … … . (name of the applicant) is a *banking company/insurer which is not a domestic company and which is operating in India through above branch(es).

2. That the said *company/insurer is entitled to receive interest, not being interest on securities (other than interest payable on securities referred to in section 393(4) [Table: Sl. No. 6]), and other sums not being dividends, charge- able under the provisions of the Act, during the tax year .

3. That it fulfils all the following conditions laid down in rule 209:

(a) ……… (name of the applicant) has been regularly assessed to income-tax in India and has furnished the returns of income for last five tax years for which such returns became due on or before the date on which the application under this rule is made.

(b) … … .. (name of the applicant) is not in default or deemed to be in default in respect of any tax (including advance tax and tax payable under section 266), interest, penalty, fine, or any other sum payable under the Act.

(c) interest or other sum is receivable by the branches on their own account and not on behalf of its head office or any branch situated outside India, or any other person;

Therefore, a certificate may be issued authorising … … . (name of the applicant) to receive interest, not being interest on securities (other than interest payable on securities referred to in section 393(4) [Table: Sl. No. 6]) and other sum not being dividends, without deduction of tax under section 393(2) (Table: Sl. No. 17), during the tax year

.

___________

I hereby declare that what is stated in this application is correct.

Place: Signature of the principal officer

Date: Name:

Designation:

Notes:

1. In case of individual, the first, middle and last name shall be provided in full without any abbreviations. In any other case also, name shall be provided in full.

2. Fill ‘person‘ status as (i) Individual (ii) Hindu undivided family (iii) Company (iv) Firm (v) Association of persons, whether incorporated or not (vi)Body of individuals, whether incorporated or not (vii) Local Au- thority (viii)Artificial Juridical Person (ix) Government (x) Trust

3. The address shall contain i. Country/Region, ii. Flat/Door/Building, iii. Road/Street/ Block/Sector, iv. PIN/ZIP Code, v. Post Office, vi. Area/locality, vii. District, viii. State.

4. Some of the information in the form would be pre-filled to the extent possible.

Part C (to be filled where applicant is a person other than the banking company/insurer)

Declaration and Request

I, … . (name of declarant) having Permanent Account Number being the principal officer of … … .. (name of the applicant), hereby declare:

1. That … .. (name of the applicant) is a non-resident assessee (not being a banking company or an insurer) carrying on business/profession in India through above branch(es).

2. That … . (name of the applicant) is entitled to receive sums (other than dividends and interest) chargeable under the provisions of the Act, during the tax year .

3. That … .. (name of the applicant) fulfils the following conditions laid down in rule 209:

(a) … … . (name of the applicant) has been carrying on business or profession in India continuously for a period of not less than five years immediately preceding the date of the application.

(b) the value of the fixed assets in India of such business or profession as shown in his books for the tax year which ended immediately before the date of the application or, where the accounts in respect of such tax year have not been made up before the said date, the tax year immediately preceding that year, exceeds fifty lakhs of rupees.

(c) ……… (name of the applicant) has been regularly assessed to income-tax in India and has furnished the returns of income for last five tax years for which such returns became due on or before the date on which the application under this rule is made.

(d) … … .. (name of the applicant) is not in default or deemed to be in default in respect of any tax (including

(e) interest or other sum is receivable by the branches on their own account and not on behalf of its head office or any branch situated outside India, or any other person;

Therefore, a certificate may kindly be issued authorising … .. (name of the applicant) to receive such sum (other than interest or dividends) without deduction of tax under section 393(2) (Table: Sl. No. 17), during the tax year … .

I hereby declare that what is stated in this application is true and correct.

Place: Signature of the principal officer

Date: Name:

Designation:

Notes:

1. In case of individual, the first, middle and last name shall be provided in full without any abbreviations. In any other case also, name shall be provided in full.

2. Fill ‘person‘ status as (i) Individual (ii)Hindu undivided family (iii) Company (iv) Firm(v) Association of persons, whether incorporated or not (vi)Body of individuals, whether incorporated or not (vii) Local Authority (viii) Artificial Juridical Person (ix) Government (x) Trust.

3. The address shall contain i. Country/Region, ii. Flat/Door/Building, iii. Road/Street/ Block/Sector, iv. PIN/ZIP Code, v. Post Office, vi. Area/locality, vii. District, viii. State.

4. Some of the information in the form would be pre-filled to the extent possible.