Application for issuance of certificate for lower or nil deduction of income-tax under section 395(1) and lower collection of income-tax under section 395(3) (To be filed electronically by Person seeking certificate for no deduction of tax or deduction or collection of tax at a

lower rate)

PART - A

Tax Year

20 – 20

1.

Details of Applicant

(a)

Name

(refer Note 1)

(b)

Address

(refer Note 2)

(c)

Status

(refer Note 3)

(d)

Permanent Account Number

(e)

Residential Status

(refer Note 4)

(f)

E-mail id

(g)

Contact Number

Country Code

Number

PART – B

2. Application filed by: (Radio Button)

o Registered non-profit organization

o Specified Entity referred to in section 263(9)(c)

o Person carrying on business or profession

o Persons other than the above

3.

Details of Request

I do hereby request that a certificate may be issued to: (tick as applicable)

□ the person responsible for paying income/sum to me with deduction of income-tax at a lower rate or without de- duction of income-tax. The details of these are mentioned in Annexure I.

□ me since I do not have the details of the payer, to receive income/sum with deduction of income-tax at a lower rate. The relevant information is included in Annexure II.

□ the person responsible for paying income/sum to me for receiving the income/sum with deduction of income-tax at a lower rate or without deduction of income-tax. The details are specified in Annexure- I. [Applicable for Regis- tered non-profit organization and Specified Entity referred to in section 263(9)(c)]

□ to me for receiving the income/sum with deduction of income-tax at a lower rate. The details are specified in An- nexure- II. [Applicable for Registered non-profit organization and Specified Entity referred to in section 263(9)(c)]

□ the Seller/Lessor/Licensor to collect income tax at a lower rate at the time of debit of such amount to my account or receipt thereof from me. The specific details are provided in Annexure III.

PART – C

4.

Details of existing tax liabilities (as on date of filing of application)

Sl.

No.

Liability

under the

Act

Tax

Year

Amount

(Advance

tax/ Self-

Assessment

tax)

Amount payable but not

paid, for which notice of

demand under section

289 or under section 156

of the Income-tax Act,

1961(43 of 1961) (as it

existed prior to its

repeal), as the case may

be, has been served

Amount

payable but

not paid in

capacity of

deductor or

collector

which has

become due

Total

liability

Remarks,

if any

(A)

(B)

(C)

(A) + (B) +

(C)

1.

Income-tax Act, 2025

(30 of 2025)

2.

Income-tax Act, 1961

(43 of 1961)

(as it existed prior to its

repeal)

5.

Particulars of income and other relevant details (for the relevant tax year)

(a)

Estimated total income

(Attach computation)

(b)

Tax including interest payable on the Total income [referred to in 5(a)]

(c)

Income claimed to be exempt and not included in the Total income in 5(a).

(Attach note giving reason for claiming such exemption)

(d)

Prepaid taxes (as per AIS):

(i) Advance Tax

(ii) Tax deducted at source

(iii) Tax collected at source

(e)

Details of return of income for four tax years preceding to the tax year:

Tax Year

Acknowledgement Number

Date of filing of return of income

Taxable

Income

Tax Liability

(i)

(ii)

(iii)

(iv)

* In case return is not filed for any of the preceding four tax years, attach computation of income for such year.

PART – D

Applicable in case of Registered Non-Profit Organisation or Specified entity referred to in rule 213

Declaration

I ………………. having Permanent Account Number … … … … … . do hereby declare that:

□ the applicant is registered vide certificate/registration number … … … … … … … … … .

□ the applicant has furnished the returns of income for last four tax years for which such returns became due on or before the date on which the application under sub-rule (1) of rule 213 is made.

□ the applicant being a specified entity referred in rule 213 is approved for the purpose of exemption from Income- tax.

□ the incomes/sum referred to in this form are not includible in the total income of any other person under sections 96 to 99.

Place: ………… Signature

Date: Name:

PART – E

Applicable in case of Person other than person mentioned in Part-D

Declaration

I ……………… having Permanent Account Number … … … … … … .. do hereby declare that:

□ the applicant has furnished the returns of income for last four tax years for which such returns became due on or before the date on which the application under sub-rule (1) of rule 213 is made.

□ the incomes/sum referred to in this form are not includible in the total income of any other person under sections 96 to 99.

Place: ………… Signature

Date: Name:

PART – F

Verification

I, (full name), having PAN in the capacity of (designation) solemnly declare that the information given above is true to the best of my knowledge and belief and no relevant information has been concealed.

Signature

Date

Address

ANNEXURE - I

[Relevant for tax deduction at source]

Please furnish following particulars in respect of the incomes/sum for which the certificate is sought

Sl.

No.

Section under which

tax at source is

liable for deduction

Table Sl. No. under which

tax at source is liable for

deduction

TAN/PAN of

the Payer

Estimated amount

of income/sum to

be received

during the tax

year

Requested Rate

of Deduction

(refer Note 5)

(1)

(2)

(3)

(4)

(5)

(6)

ANNEXURE - II

[Relevant for tax deduction at source]

Please furnish following particulars in respect of the incomes/sum for which the certificate is sought

(Please upload a note justifying the issue of certificate under sub-rule 9 of rule 213)

Sl.

No.

Section under which

tax at source is liable

for deduction

Table Sl. No. under which

tax at source is liable for

deduction

Estimated amount of

income/sum to be received

during the tax year

Requested Rate of

Deduction (refer Note 5)

(1)

(2)

(3)

(4)

(5)

ANNEXURE -III

[Relevant for tax collection at source];

Please furnish following particulars in respect of amount receivable for which the certificate is sought

Sl.

No.

Section under which tax at source is liable

Table Sl. No. under which tax at source is liable for

TAN of the

Seller/ Lessor/

Estimated

amount to be

Requested Rate

of Collection

for collection

collection

Licensor

debited/paid

during the tax

year

(1)

(2)

(3)

(4)

(5)

(6)