Intimation of settlement of dispute regarding foreign tax for which credit has not been claimed

Part A: Particulars ofthe Person

1.

Name:

(refer Note 1)

2.

Address:

(refer Note 2)

3.

Permanent Account Number (PAN):

4.

Relevant Tax Year:

5.

Acknowledgement Number of Form No. 44:

6.

Date of settlement of dispute:

(refer note 4)

7.

Details of the Intimation (refer Note 3)

Intimation Number

Acknowledgement Number of the Intimation

Foreign tax credit claimed

I-1

I-2

Part B: Other Information

Details of income from a country or specified territory outside India which is offered to tax or assessed to tax in India and on which Foreign Tax Credit is claimed:

S

l.

N

o.

Na

me of the

cou

ntry /

regi

on

Taxpa yer

Identif

ication

Numb er

(TIN)

Sourc

e of

incom e

Inc

om e

fro m out

side

Indi a

Income-

tax paid outside

India

Tax

pay

able on suc h

in-

com e

un-

der

the

In-

com e-

tax

Act,

202

5

Details of foreign tax credit under section 159

Am

oun

t of

for-

eig n tax

cre dit un-

der

sec-

tion

160

Whet her

amou

nt in

colu mn

(6) or

(12) or

any part there

of is

under

dispu te?

If

‘Yes

‘ in

colu

mn

(13)

,

amo

unt of suc h

disp

uted

fore

ign

tax

cred it

Tota l

forei gn

tax cred it

[(15

) =

(11+

12)]

Tot al

fore

ign

tax

cre dit clai

me d

[(16

) =

(14)

-

(15)

]

Am

oun t

R

at

e

Articl

e No. of

Doubl e

Taxati on

Avoid ance Agree

ments

Rate

of tax

as per

Doubl e

Taxati on

Avoid ance Agree

ments

Am

oun t

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

Salary

House

prope

rty

Busin

ess or

profes

sional

Long

term

capita

l gain

Short

term

capita

l gain

Intere

st

Divid

end

Royalt

y)

Fees

for

techni

cal

servic

es or

fee for

includ

ing

servic

es

Other

s

Part C: Details of the Intimation of settlement of dispute regarding foreign tax for which credit has not been

claimed

Total disputed foreign tax credit reported in Form No. 44 {total of amounts in column (14) of Part B of Form No. 44} [B] (refer Note 6)

Total disputed foreign tax credit reported vide this Intimation I-1 (total of amounts in column (14) [B1] (refer Note 6)

Total Foreign Tax Credit claimed vide this Intimation I-1 = [B] - [B1] (refer Note 6)

Declaration and verification

I, , hereby declare that the information provided above is true and correct to the best of my knowledge. I have not concealed any relevant fact. I confirm that the amount of Foreign Tax Credit claimed by  (name of the taxpayer) for the tax year is in accordance

with the applicable Double Taxation Avoidance Agreement(s) and relevant provisions of the Income-tax Act, 2025 (30 of 2025) and Income-tax Rules, 2026 I am submitting this form in my capacity as ___________ (Designation), holding PAN and I am competent to submit this form.

Date: Signature:

Place: Name:

Verification by an accountant

I holding PAN have examined the books of account and other documents showing the particulars of income from a country or specified territory outside India and evidence of Foreign Tax paid thereon by the (name of the assessee) for the tax year   and evidence of settlement of dispute thereof in terms of the section 288(1)[Table: Sl. No.7]. The amount of Foreign Tax Credit claimed by (name of the assessee) for the tax year  in Part B and/or the details furnished in Part C of this form are in accordance with the applicable Double Taxation Avoidance Agreement(s) and relevant provisions of the Income-tax Act, 2025 (30 of 2025) and Income-tax Rules, 2026.

I affirm that the above particulars are true and correct to the best of my/our knowledge and belief.

Place: Signature:

Date: Name of the accountant:

Designation:

Membership Number:

UDIN, if any:

Name of the Proprietorship/Firm:

Firm Registration Number: