Form of undertaking to be furnished under section 420(1)

To

[Designation of Prescribed Authority]

In consideration of a no objection certificate to be issued under the provisions of section 420(1), I hereby undertake to pay to the Government of India the taxes which are or may become payable under the Act or the Wealth-tax Act, 1957 (27 of 1957) or the Gift-tax Act, 1958 (18 of 1958) (as it existed prior to its repeal) or the Income-tax Act, 1961 (43 of 1961) (as it existed prior to its repeal) or the Expenditure-tax Act, 1987 (35 of 1987) or the Black Money (Undisclosed Foreign Income and Assets) and Imposition of Tax Act, 2015 (22 of 2015) in respect of the income earned during the period of employment under me, income received from me by the person whose details are in Part B.

Part A: Details of the Employer

1.

Name

(Refer Note 1)

2.

Permanent Account Number

3.

Address

(Refer Note 2)

4.

Contact details

Mobile Number

Country Code

Number

Email ID

Part B: Information of the Person Leaving India

5.

Name

(Refer Note 1)

6.

Name of *Father/Husband

(Refer Note 1)

7.

Permanent Account Number (if available)

8.

Passport Number/Emergency Certificate Number details

(i)

Passport /Emergency certificate number

(ii)

Date of Issue

dd/mm/yyyy

(iii)

Country where issued

(iv)

Place where issued

9.

Contact Details

(i)

Mobile Number

Country Code

Number

(ii)

Email ID

2. I further undertake that any amount certified by the Assessing Officer having ju- risdiction in the case of the person referred in Part-B as due and payable by him under all or any of the aforesaid enactments or other enactment(s) shall be ac-

cepted by me as conclusive evidence of the said amount being due and payable as aforesaid, and no such amount shall, in any case and under any circumstances, be disputed.

3. Further, I hereby undertake and declare that this undertaking shall not be deter-

mined or otherwise affected by any death/dissolution or liquidation, but shall re- main in full force and effect against me and my estate/assets until such amount of tax as is or may become due and payable hereunder is paid in full.

4. I further undertake that without prejudice to any other remedies open to the Cen- tral Government for recovering any tax which is or may become due and payable under this undertaking, the Central Government will be entitled to recover the

said tax from me, in accordance with rule 225 to Income-tax Rules, 2026 or any modification thereof from time to time, and it shall not be necessary for the Cen- tral Government to initiate and/or exhaust any legal proceedings against the as- sessee(s) for the recovery of any tax as is aforementioned before suing me for the recovery of the same.

*Delete whichever is not applicable

Place:

Date:

(Signature)

Name: Designation:

Employer referred to in section 420(1)(i)

or

Any other person referred to in section 420(1)(ii)