Quarterly statement to be furnished by an authorised dealer in respect of remittances made for the quarter of … of (Tax Year)
1. | Name | (refer Note 1) | |
2. | Address | (refer Note 2) | |
3. | Permanent Account Number | ||
4. | Email id | ||
5. | Contact number | Country Code | Number |
6. | ITDREIN | ||
Part B: Particulars of remittance made
Remitter Details | Remittee Details | Remittance Details | ||||||||||
Sl. No . | Nam e | Permane nt Account Number | Nam e | Permane nt Account Number, if available | Tax Identificati on Number, if available (refer Note 3) | Countr y of which remittee is a residen ce | Amou nt | Da te | Full particula rs ofthe Account to which remittan ce is made | Purpo se Code as per RBI | Form No. 145 acknowledgm ent no. | If Form No. 145 not require d enter require d code as per Note 4 |
DECLARATION
I ………………………..(full name), having Permanent Account Number … … … .. in my capacity as …
(designation) … . of …… (name of the authorised dealer) declare that the information given above are correct, true and complete.
Place
Date
Signature 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. The address shall contain Country/Region, ii. Flat/Door/Block number iii. Road/Street/Block/Sector, iv. PIN/ZIP Code, v. Post Office, vi. Area/locality, vii. District, viii. State.
3. Tax Identification Number of the deductee in the country or specified territory of his residence and in case no such number is available, then a unique number on the basis of which the deductee is identified by the Government of that country or the specified territory of which he claims to be a resident.
4. i) Write “A” if furnishing of Form No. 145 is exempt under rule 220(3)(a) ii) Write “B” if furnishing of Form No. 145 is exempt under rule 220 (3)(b) iii) Write “C” if furnishing of Form No. 145 is exempt under rule 220 (3)(c)
5. Some of the information in the form would be pre-filled to the extent possible.