Statement of Specified Financial Transactions under section 508(1)

A.1

REPORTING ENTITY DETAILS

A.1.1

Reporting Entity Name

A.1.2

Income-Tax Department Reporting Entity Identi- fication

Number

.

A.2

STATE-

MENT DE- TAILS

A.2.1

Statement Type

Insert 2 character code

A.2.2

Statement Number

A.2.3

Original Statement Id

A.2.4

Reason for Correction

Insert 1 character code

A.2.5

Statement Date

A.2.6

Reporting Period

A.2.7

Report Types

Insert 2 character code

A.2.8

Number of Reports

A.3

PRINCIPAL OFFICER DETAILS

A.3.1

Name

A.3.2

Designation

A.3.3

Address

A.3.4

City / Town

A.3.5

Postal Code

A.3.6

State Code

Insert 2 character code

A.3.7

Country Code

Insert 2 character code

A.3.8

Telephone

A.3.9

Mobile

A.3.10

Email

B.1

REPORT NUMBER (To be provided for each person being reported)

B.1.1

Report Serial Number

B.1.2

Original Report Serial Number

B.2

PERSON DETAILS FOR AGGREGATED FINANCIAL TRANSACTIONS

B.2.1

For Persons having PAN

B.2.1.1

Person Name

B.2.1.2

Person Type

工二 Insert 2 character code

B.2.1.3

Father‘s Name (for Individuals)

B.2.1.4

PAN

B.2.1.5

Address

B.2.1.6

Postal Code

B.2.1.7

State Code

B.2.1.8

Country Code

B.2.2

For Persons having No PAN

B.2.2.1

Person Name

B.2.2.2

Person Type

B.2.2.3

Father‘s Name (for Individuals)

B.2.2.4

Aadhaar Number (for Individuals)

B.2.2.5

Form 97 Acknowledgement

B.2.2.6

Identification Type

Insert 1 character code

B.2.2.7

Identification Number

B.2.2.8

Date ofBirth/ Incorporation

B.2.2.9

Nationality/Country of Incorporation

Insert 2 character code

B.2.2.10

Business or occupation

B.2.2.11

Address

B.2.2.12

Address Type

Insert 1 character code

B.2.2.13

City / Town

B.2.2.14

Postal Code

B.2.2.15

State Code

Insert 2 character code

B.2.2.16

Country Code

Insert 2 character code

B.2.2.17

Mobile/Telephone Number

B.2.2.18

Other Contact Number

B.2.2.19

Email

B.2.3

Number of persons if Financial Transaction is undertaken in joint name

Insert 2 character code

B.2.3.1

Names of persons engaged in the transaction jointly

(Repeat, if required)

B.2.3.2

PAN of person/ persons engaged in

the transaction jointly

(Repeat, if required)

B.3

FINANCIAL TRANSACTION SUMMARY

B.3.1

Product Type

Insert 2 character code

B.3.2

Aggregate gross amount received from the person

B.3.3

Aggregate gross amount

received from the person in cash

B.3.4

Aggregate gross amount paid to the person

B.4

FINANCIAL TRANSACTION DETAILS (To be provided for each distinctive product)

B.4.1

Product Identifier

B.4.2

Last Date of Transaction

B.4.2

Aggregate gross amount received from the person

B.4.4

Aggregate gross amount received from the person in

cash

B.4.5

Aggregate gross amount paid to the person

B.4.6

Whether Time Deposit is created by Auto-sweep?

Insert 1 character code

B.4.7

Parent Account Number related to Time Deposit created by Auto

Sweep

C.1

REPORT NUMBER (To be provided for each account being reported)

C.1.1

Report Serial Number

C.1.2

Original Report Serial Number

C.2

ACCOUNT DETAILS

C.2.1

Account Type

工二 Insert 2 character code

C.2.2

Account Number

C.2.3

Account Holder Name

C.2.4

Account Status

Insert 1 character code

C.2.5

Branch Reference Number

C.2.6

Branch Name

C.2.7

Branch Address

C.2.8

City Town

C.2.9

Postal Code

C.2.10

State Code

Insert 2 character code

C.2.11

Country Code

Insert 2 character code

C.2.12

Telephone

C.2.13

Mobile

C.2.14

Email

C.3

ACCOUNT SUMMARY

C.3.1

Aggregate gross amount

credited to the account in cash

C.3.2

Aggregate gross amount

debited to the account in cash

C.4

PERSON DETAILS (To be provided for each person related to the account)

C.4.1

For Persons having PAN

C.4.1.1

Account Relationship

Insert 1 character code

C.4.1.2

Person Name

C.4.1.3

Person Type

Insert 2 character code

C.4.1.4

Father‘s Name (for Individuals)

C.4.1.5

PAN

C.4.1.6

Address

C.4.1.7

Postal Code

C.4.1.8

State Code

C.4.1.9

Country Code

C.4.2

For Persons having No PAN

C.4.2.1

Person Name

C.4.2.2

Person Type

C.4.2.3

Father‘s Name (for Individuals)

C.4.2.4

Aadhaar Number (for Individuals)

C.4.2.5

Form 97 Acknowledgement

C.4.2.6

Identification Type

Insert 1 character code

C.4.2.7

Identification Number

C.4.2.8

Date of Birth/ Incorporation

C.4.2.9

Nationality/Country of Incorporation

工二 Insert 2 character code

C.4.2.10

Business or Occupation

C.4.2.11

Address

C.4.2.12

Address Type

Insert 1 character code

C.4.2.13

City / Town

C.4.2.14

Postal Code

C.4.2.15

State Code

工二 Insert 2 character code

C.4.2.16

Country Code

工二 Insert 2 character code

C.4.2.17

Mobile/Telephone Number

C.4.2.18

Other Contact Number

C.4.2.19

Email

D.1

REPORT NUMBER (To be provided for each transaction being reported)

D.1.1

Report Serial Number

D.1.2

Original Report Serial Number

D.2

TRANSACTION DETAILS

D.2.1

Transaction Date

D.2.2

Transaction Identity

D.2.3

Transaction Type

Insert 1 character code

D.2.4

Transaction Amount

D.2.5

Cash in Transaction Amount

D.2.6

Property Type

Insert 1 character code

D.2.7

Whether property is within municipal limits

Insert 1 character code

D.2.8

Property Address

D.2.9

City / Town

D.2.10

Postal Code

D.2.11

State Code

Insert 2 character code

D.2.12

Country Code

Insert 2 character code

D.2.13

Stamp Valuation of Property for de- termination of Stamp Duty

D2.14

Value of Stamp paper

(applicable for Stock Holding Cor- poration of India Ltd)

D.3

PERSON DETAILS ((To be provided for each person related to the transaction)

D.3.1

For Persons having PAN

D.3.1.1

Transaction Relation

Insert 2 character code

D.3.1.2

Transaction Amount related to the person

D.3.1.3

Person Name

D.3.1.4

Person Type

Insert 2 character code

D.3.1.5

Father‘s Name (for Individuals)

D.3.1.6

PAN

D.3.1.7

Address

D.3.1.8

Postal Code

D.3.1.9

State Code

D.3.1.10

Country Code

D.3.2

For Persons having No PAN

D.3.2.1

Person Name

D.3.2.2

Person Type

D.3.2.3

Father‘s Name (for Individuals)

D.3.2.4

Aadhaar Number (for Individuals)

D.3.2.5

Form 97 Acknowledgement (not applicable for item D.2.14)

D.3.2.6

Identification Type

Insert 1 character code

D.3.2.7

Identification Number

D.3.2.8

Date of Birth/ Incorporation

D.3.2.9

Nationality/Country of Incorporation

Insert 2 character code

D.3.2.10

Address

D.3.2.11

City / Town

D.3.2.12

Postal Code

D.3.2.13

State Code

Insert 2 character code

D.3.2.14

Country Code

Insert 2 character code

D.3.2.15

Mobile/Telephone Number

D.3.2.16

Other Contact Number

D.3..2.17

Email