Certificate of accountant in respect of compliance to the provisions of Schedule V [Table: Sl. No. 7] by the notified Pension Fund

Part A: Particulars ofthe Pension Fund (PF)

1.

Name:

(refer Note 1)

2.

Address:

(refer Note 2)

3.

Permanent Account Number (PAN):

4.

E-mail Id:

5.

Contact Number:

Country Code

Number

Part B: Particulars ofthe Pension Fund (PF)

6.

Tax Year:

7.

Total Income of the PF during the tax year:

8.

Total amount of income eligible for exemption under Schedule V [Table: Sl. No.7] (as per details in Sl. No. 10 (column K) of this Part):

9.

The opening balance (i.e. the closing balance as on the last date of the preceding financial year) of the investment made which is eligible for exemption under Schedule V [Table: Sl. No.7] of the Act:

10.

Details of investment made by the PF during the tax year:

Sl.

No.

Date of

investment

Amount of

investment

Nature of

investment

(refer Note

3)

Nature

of

income

(Note

4)

Amount of

income on

investment

during the

year

Details of the entity in which investment made

Amount of

income

which is

eligible for

exemption

under

Schedule

V [Table:

Sl. No. 7]

(Attach

calculation

sheet as

per

relevant

rules)

Nature

of

entity

(refer

Note

5)

Name

PAN

If nature of

entity code

is 3/4/5,

whether

the entity

has made

minimum

investment

of 50% or

75% or

90% as

required in

Schedule

V [Table:

Sl. No. 7]

(Attach

calculation

sheet as

per

relevant

rules)

A

B

C

D

E

F

G

H

I

J

K

1.

2.

Total

11.

Whether the PF has sold any of the investments made for the purposes of exemption under Schedule V [Table: Sl. No.7] before the expiry of 3 years from the date on which the investment was made in respect of the said exemption:

Yes/No

12.

If answer to Sl. No. 11 is yes, then provide the following details:

Sl. No.

Date of

investment

Nature of

investment

(refer Note

3)

Nature of

income

(refer

Note 4)

Amount of

income on

investment

during the

year

Details of the entity in which investment was made

Date of Sale

Nature of

entity (refer

Note 5)

Name

PAN

A

B

C

D

E

F

G

H

I

1.

2.

Total

13.

The PF satisfies all the conditions required for the purposes of the exemption under Schedule V [Table: Sl. No. 7], that are:

(a)

Name of the law under which the PF is created or established

(b)

Details of the funds or plans for which the PF is responsible for administering or investing the assets for:

Sl.

No.

Name of the fund/ plan

Purpose for which fund/plan is

established (refer Note 6)

Nature of the fund/plan (refer Note 7)

Percentage of value of assets received from each fund/plan to total value of assets administered or invested by the PF

A

B

C

D

E

1.

2.

(c)

If some of the funds/plans administered or invested by the PF are in the nature of SWF, then whether they fulfil the following conditions:

Yes/No

(i)

assets of these funds/plans are wholly owned directly or indirectly by the Government of a foreign country; and

(ii)

such assets vests in the Government of such foreign country upon dissolution

(d)

Whether portion of the earnings or assets of the PF inures any benefit to any private person (other than for meeting statutory obligations and defined contributions for participants or beneficiaries of funds or plans referred to in rule 282; or for any payment made to creditors or depositors for loan or borrowing (as defined in Schedule V [Table: Sl. No. 7.Note 5(c)]) taken for the purposes other than for making investment in India):

Yes/No

(e)

If answer to (d) is Yes, then provide the following details:

(i)

Name of such private person

(ii)

Amount of benefit provided during the year

(f)

Whether it participates in the day-to-day operations of any of the investee, as defined in Schedule V [Table: Sl. No. 7.Note 5(b)], barring any monitoring mechanism to protect the investment with the investee including the right to appoint directors or executive director:

Yes/No

(g)

If answer to (f) is Yes, then provide the following details:

(i)

Name of such investee

(ii)

PAN of the investee

(iii)

Amount of investment in such investee at the end of the year

(h)

Whether it has loans or borrowings, as defined in Schedule V [Table: Sl. No. 7.Note 5(c)], directly or indirectly, for the purposes of making investment in India:

Yes/No

(i)

If answer to (h) is Yes, then provide the following details:

(i)

Name of the person from whom such loan or borrowing has been taken

(ii)

Amount of loan or borrowing at the beginning of the year

(iii)

Amount of loan or borrowing received during the year

(iv)

Amount of loan or borrowing repaid during the year

(v)

Amount of loan or borrowing at the end of the year

(j)

Whether separate segmented account is maintained for income and investment in respect of investment which qualifies for exemption under Schedule V [Table: Sl. No.7]:

(k)

Whether it is liable to tax in such foreign country:

Yes/No

(l)

In answer to (k) is Yes, then whether exemption from taxation for all its income has been provided by such foreign country:

(m)

Quarter for which the intimation in Form No. 175 has been filed during the tax year.

(refer Note 8)

Certification & Verification

I have examined the relevant accounts, documents and records of (name of the Pension Fund) having PAN and which has been notified under Schedule V [Table: Sl. No. 7] of the Income-tax Act, 2025 (30 of 2025) or section 10 (23FE) of the Income-tax Act, 1961 (43 of 1961) (as it existed prior to its repeal) vide Notification Number dated (dd/mm/yyyy), for the period from (dd/mm/yyyy) to (dd/mm/yyyy).

I fully understand that any statement made in this certificate, if proved incorrect or false will render me liable for any penal or other consequences as may be prescribed in law or is otherwise warranted.

Nature of Investment

Code

Debt

1

Equity

2

Preference Shares

3

Others (Please specify)

4

Nature of Income

Code

Interest

1

Dividends

2

Capital Gains

3

Others (Please specify)

4

Nature of entity in which investment is made

Code

Business Trust referred to in Schedule V [Table: Sl. No. 7.D(a)(iii)(A)]

1

Eligible Infrastructure Facility referred to in Schedule V [Table: Sl. No. 7.D(a)(iii)(B)]

2

Eligible Alternative Investment Fund referred to in Schedule V [Table: Sl. No. 7.D(a)(iii)(C)]

3

Eligible Domestic Company referred to in Schedule V [Table: Sl. No.

7.D(a)(iii)(D)]

4

Eligible Non-Banking Financial Company referred to in Schedule V [Table: Sl. No. 7.D(a)(iii)(E)]

5

Purpose of the fund/plan

Code

Retirement

1

Social Security

2

Employment

3

Disability

4

Death benefits

5

Similar compensation (Please specify)

6

Nature of the fund/plan

Code

Pension Fund

1

Sovereign Wealth Fund

2

Others

3

Intimation in Form No. 175

Code

Quarter ending 30th June of the tax year

1

Quarter ending 30th September of the tax year

2

Quarter ending 31th December of the tax year

3

Quarter ending 31th March of the tax year

4