Annual Statement under section 505

Part A: Particulars pertaining to non-resident person having liaison office in India

1.

Name:

(refer Note 1)

2.

Permanent Account Number (PAN):

3.

Tax Identification Number (TIN), if any, in the country of incorporation or resi- dence:

4.

Details of head office:

(i)

Address:

(refer Note 2)

(ii)

Country of residence:

(iii)

E-mail Id:

(iv)

Contact Number:

Country

Code

Number

5.

Details of principal office in India:

(i)

Address:

(refer Note 2)

(ii)

E-mail Id:

(iii)

Contact Number:

Country

Code

Number

6.

Date of submitting Annual Activity Certificate for the tax year to the Reserve Bank of India:

7.

Details of the Chartered Accountant signing the Annual Activity Certificate as prescribed by the Reserve Bank of India:

(i)

Name:

(refer Note 1)

(ii)

Address:

(refer Note 2)

(iii)

PAN:

(iv)

Unique Document Identification Number (UDIN):

(v)

Membership Number:

(vi)

Name of the Firm/ Proprietorship:

(vii)

Firm Registration Number:

(viii)

E-mail Id:

(ix)

Contact Number:

Country

Code

Number

8.

Tax Year for which the Statement is being submitted:

Part B: Other Information

9.

Details of officer in charge for each office of the non-resident person in India:

Sl.

No.

Name

Designation

E-mail Id

Contact number

Address of office

1.

2.

(Repeat, if required)

10.

Details of any salary or compensation of any sort payable outside India to any employee working in India or for services rendered in India:

Sl.

No.

Name of em- ployee

PAN (if

allotted)

E-mail Id

Contact

number

Address of

employee in India, if any

Amount of salary or compensation

1.

2.

(Repeat, if required)

11.

Details of agents or representatives or distributors of the non-resident person in India:

Sl.

No.

Name of agent or rep- resentative or distribu- tor

PAN

E-mail Id

Contact number

Address

1.

2.

(Repeat, if required)

12.

Details of Liaison Office of the non-resident person (data in Sl. No. 13 to Sl. No. 23. to be furnished Liaison Office wise, multiple sets can be filled based on the number of Liaison Office):

13.

Date of the Reserve Bank of India approval for Liaison Of- fice opening:

14.

Liaison Office Registration Number granted by the Reserve Bank of India:

15.

Date of opening of Liaison Office in India:

16.

Address of Liaison Office in India:

E-mail Id

Contact number

Address

17.

Nature of activities undertaken by Liaison Office:

18.

Details of products or services for which liaisoning activity is done by the Liaison Office:

Sl. No.

Liaisoning activity is done for products or services

Description of products or services

1.

2.

(Repeat, if required)

19.

Whether there are other group entity or entities operating from the same premises as the office of the Liaison Office? If Yes, provide the following details in respect of such entity or entities:

Yes/No

Sl.

No.

Name of the

entity

PAN of

the entity

E-mail Id

Contact

number

Address of the enti- ty

Nature of activity un- dertaken by the entity

1.

2.

(Repeat, if required)

20.

Does the Liaison Office perform liaisoning activity for any other entity or entities? If Yes, provide the following details in respect of such entity or entities:

Yes/No

Sl. No.

Name of the entity

PAN of the entity

E-mail Id

Contact number

Address of the entity

1.

2.

(Repeat, if required)

21.

Details of the top five parties in India with whom the Liaison Office has been doing the liaisoning:

Sl. No.

Name of the party

PAN of the

party

E-mail Id

Contact number

Address of the party

1.

2.

(Repeat, if required)

22.

Total number of employees working in the Liaison Office during the year:

23.

Details of employees working in the Liaison Office drawing salary or compensation of ₹ 50,000 or above per month:

Sl.

No.

Name of the employee

PAN (if

allotted)

E-mail Id

Contact

number

Designation

Amount of salary or compensation

Address of

sitting loca- tion

1.

2.

(Repeat, if required)

24.

India specific financial details for the financial year i.e., receipts and expenses of the non-resident person from or in India (not limited to the Liaison Office(s)):

(i)

In respect of the Liaison Office(s):

Sl. No.

Liaison Office Regis- tration Number

Receipts

Expenses

1.

2.

(Repeat, if required)

(ii)

In respect of the non-resident person, including of Liaison Office(s) mentioned above:

Sl. No.

Receipts

Expenses attributable to receipts from India

1.

2.

(Repeat, if required)

25.

Details of all purchases, sales of material, and services from/to Indian parties during the year by the non- resi- dent person (not limited to transactions made by Liaison Office (s)):

(i)

In respect of the Liaison Office(s):

Sl.

No.

Nature of

transaction

Name of the

Indian par- ty

with whom

transaction is done

PAN

of the

Indian

party

E-mail Id

Contact number

Address

of the Indian

party

Amount of transaction

1.

2.

(Repeat, if required)

(ii)

In respect of the non-resident person, including of Liaison Office(s) mentioned above:

Sl.

No.

Nature of

transaction

Name of the

Indian par- ty

with whom

transaction is done

PAN

of the

Indian

party

E-mail Id

Contact number

Address

of the Indian

party

Amount of transaction

1.

2.

(Repeat, if required)

26.

Whether there is any group entity or entities (including Indian entity/entities of the group or permanent establishment of foreign entity or entities of the group in India) present in India as Branch Office or Companies or Limited Liability Partnerships etc.? If Yes, provide the following details:

Yes/No

Sl.

No.

Name of the entity

PAN of the entity

E-mail Id

Contact

number

Address of the entity

Nature of

business ac- tivities

1.

2.

(Repeat, if re- quired)

27.

Whether there are other Liaison Offices ofthe group entities in India? If Yes, provide the following details:

Yes/No

Sl.

No.

Name of the entity having

the Liaison Office(s)

PAN of the entity

E-mail Id

Contact

number

Address of the entity

Nature of

activities un-

dertaken by

the Liaison Office(s)

1.

2.

(Repeat, if re- quired)

Verification

I, , hereby affirm that the information provided in this application is true and correct to the best of my knowledge. I have not concealed any relevant fact.

I am submitting this application in my capacity as (designation), holding PAN and I am competent to verify and submit this application.