Information and Documents to be furnished by an Indian concern under section 506

Part A: Particulars ofthe Indian concern

1.

Name:

(refer Note 1)

2.

Address:

(refer Note 2)

3.

Status:

(refer Note 3)

4.

Residential Status:

(refer Note 4)

5.

Permanent Account Number (PAN):

6.

E-mail Id:

7.

Contact Number:

Country

Code

Number

Part B: Other Information

8.

Tax Year:

9.

Whether the Indian concern has been designated to provide information on behalf of the group? If Yes, provide the following details:

(i)

details of all the Indian concerns which are constituent of the group:

(a)

Name:

(b)

Address:

(c)

PAN:

(d)

Aadhaar:

(ii)

if the information is being furnished on behalf of any Indian concern(s) details of such concern(s):

(a)

Name:

(b)

Address:

(c)

PAN:

(d)

Aadhaar:

10.

Details of the holding entities:

(i)

Immediate holding entity:

(a)

Name:

(b)

Country/ region of incorporation:

(c)

Country/ region of which it is tax resident:

(d)

Tax Identification Number (TIN), in the country/ region of residence:

(ii)

Intermediate holding entity:

(a)

Name:

(b)

Country/ region of incorporation:

(c)

Country/ region of which it is tax resident:

(d)

TIN in the country/ region of residence:

(iii)

Ultimate holding entity:

(a)

Name:

(b)

Country/ region of incorporation:

(c)

Country/ region of which it is tax resident:

(d)

TIN in the country/ region of residence:

11.

Details of the company(ies) or entity(ies) that derive its value substantially from assets (whether tangible or intangible) located in India, which are held in, or through, the Indian concern;

Sl. No.

Name

Country/region of incorporation

Country/ region of which it is tax resident:

TIN in the country/ region of residence:

1.

2.

(Repeat, if required)

Part C: Information to be filled for reporting the information in respect of transfer of share/interest of the concern(s) or entity(ies) referred to in Part B (Sl. No. 11) the income from which is deemed to accrue or arise in India under the provisions of section 9(10)(a)

12.

Name of the company or entity:

13.

Details of the transaction(s):

(i)

Nature of transaction:

(ii)

Name of the transferor:

(iii)

Address of the transferor:

(iv)

PAN of the transferor:

(v)

Country/ region of tax residency:

(vi)

TAN of transferor:

(vii)

Name of transferee:

(viii)

Address of transferee:

(ix)

PAN of transferee:

(x)

TAN of transferee:

(xi)

Other details:

Date of transfer

Total sale consideration

Date of acquisition

Cost of acquisition

14.

Percentage share/interest transferred including holding percentage of transferor during the period of 12 months preceding the transfer:

15.

Value of total assets of the company or the entity

16.

Value and breakup of assets of the Indian concern:

Sl. No.

Name of the asset

Value of the asset at beginning of the year

Value of the asset at the end of the year

1.

2.

(Repeat, if required)

17.

Other details to be provided as separate enclosure:

(attach as per Note 6)

18.

Whether any transaction in respect of share of, or interest in, any company or entity referred to in Part B (Sl. No. 11) has the effect of transferring the right of management or control over the Indian concern? If Yes, provide information as per Part D.

Yes/No

Part D: Information to be filled in to report the transaction respect of transfer of share/interest during the tax year resulting in transfer of right of management or control)

19.

Name of the company or entity:

20.

PAN of the company or entity:

21.

Details of the transaction(s):

(i)

Total consideration of the transaction(s):

(ii)

Nature of transaction:

(iii)

Name of the transferor:

(iv)

Address of the transferor:

(v)

PAN of the transferor:

(vi)

Name of transferee:

(vii)

Address of transferee:

(viii)

PAN of transferee:

22.

Percentage share/interest transferred including percentage holding of transferor during the period of 12 months preceding the transfer:

23.

Holding structure in respect of shares of, or interest in, the company or entity before and after the transfer:

Sl. No.

Name of the company or entity

% of shareholding before the transfer

% of shareholding after the transfer

Remarks

1.

2.

(Repeat, if required)

24.

Value and breakup of assets of the Indian concern on the specified date as per section 9(10)(a):

Sl. No.

Name of the asset

Value of the asset at beginning of the year

Value of the asset on the specified date

1.

2.

(Repeat, if required)

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.

(I)

Company

(II)

Limited Liability Partnership

(III)

Firm

(IV)

Permanent Establishment

(V)

Other, specify

(I)

Resident

(II)

Non-resident

(III)

Resident but not ordinarily resident

Anne

xure

Particulars

A-1

Basis of valuation of assets in Part C (Sl. No. 15 and 16) and Part D (Sl. No. 24).

A-2

Details of supporting documents in respect of A-1.

A-3

Financial and accounting statements ofthe company or the entity.

A-4

Basis of determining the location of share or interest being transferred.