Application for opting for Safe Harbour

Part A: Particulars ofthe Person

1.

Name:

(refer Note 1)

2.

Address:

(refer Note 2)

3.

Permanent Account Number (PAN):

4.

Nature of business or activities of the assessee:

5.

Status:

(refer Note 3)

6.

E-mail Id:

7.

Contact Number:

Country

Code

Number

Part B: Other Information

I. Option for safe Harbour

8.

Safe Harbour is opted for the following transactions (select one or more): (refer Note 4)

1. Eligible International Transaction (EIT)

(i) Provision of information

technology

services;

(ii) Others

2. Eligible Specified

Domestic Transaction (ESDT)

3. Eligible Business (EB)

II. Tax Year(s)

9.

Tax year(s) for which the option is to be exercised (refer Note 5):

(i)

In the case ofEIT (other than provision of information technology services), ESDT or EB, provide the following details:

(a)

Tax Year:

(b)

Date of furnishing of return of income for the tax year:

(ii)

In the case ofEIT being provision of information technology services, provide the following details (refer Note 5):

(a)

Tax Years for which option is to be exercised:

III. Eligible International Transaction (EIT)

10.

(i)

Nature of EIT:

Provision of information technology services

(ii)

Aggregate operating revenue of the EIT (total amount should not exceed two thousand crore rupees):

(a)

Operating revenue of provision of information technology enables services:

(b)

Operating revenue of provision of knowledge process outsourcing services:

(c)

Operating revenue of provision of contract research and development services wholly or partly relating to software development:

(d)

Operating revenue of provision of software development services:

(iii

)

Details of EIT:

Sl.

No.

Details of the Associated Enterprise (AE) with whom EIT has

been entered into

Operating Profit (OP) margin in relation to Operating Expense

Name

Address

PAN, if

availab

le

Taxpayer

Identificatio

n Number

or its

equivalent

in the

country/regi

on of

location

Count

ry or

region

in

which

AE is

locate

d

(refer

Note

7)

Operatin

g

Revenue

(OR)

Operatin

g

Expense

(OE)

OP

margin

(OP/OE)

A

B

C

D

E

F

G

H

I

1.

2.

(Repeat, if

required)

11

.

(i)

(a

)

Nature of EIT (refer Note 6):

(b

)

Details of EIT:

Sl.

No

.

Details of the Associated Enterprise (AE) with whom EIT has

been entered into

Operating Profit (OP) margin in relation to Operating Expense

Name

Addre ss

PAN, if

availabl e

Taxpayer

Identificatio

n Number or its

equivalent in the

country/regi

on of

location

Country or region in which AE is located (refer Note 7)

Operati ng

Revenu

e (OR)

Operati ng

Expense (OE)

OP

margin

(OP/O E)

A

B

C

D

E

F

G

H

I

1.

2.

(Repea

t, if

require

d)

(ii

(Repeat, if required)

)

12

.

(i)

Nature of EIT:

Advancing intra-group loans by the eligible assessee

(ii

)

If the loan is in foreign currency, whether the loan advanced to the Associated Enterprise (AE) including all loans to all AEs exceed INR two hundred and fifty crore rupees as on 31st March of the tax year:

Yes/No

(iii

)

Details of EIT:

Sl

.

N

o.

Details of the AE with whom EIT has been entered into

The

rate at

whic h

inter est has

been

char

ged

Amo unt of

loan

Curre

ncy of loan

Name

Addr ess

PAN, if

availa ble

Taxpayer

Identifica tion

Number

or its

equivalen

t in the

country/r

egion of location

Coun

try or

regio

n in

whic

h AE is

locat ed

(refe r

Note 7)

Whet her

credit

rating

of AE has

been

done

(Yes/ No)

Wher e

credit

is not

availa ble

and

the

loan

is in

Indian

curren cy,

wheth

er the loan

advan

ced to the

AE

includ ing

loans

to all AEs

excee

d INR 100

crores

as on 31st

Marc

h of the

tax

year (Yes/ No)

Cre dit Rati ng Ran k

Cred it

Rati ng Age

ncy

A

B

C

D

E

F

G

H

I

J

K

L

M

1.

2.

(Repe

at, if

requir

ed)

1

3.

(i)

Nature of EIT:

Providing corporate

guarantee(s) by the eligible assessee

(ii

)

Whether the amount guaranteed does exceed INR hundred crore rupees:

Yes/No

(ii

i)

Details of EIT:

Sl.

No

.

Details of the Associated Enterprise (AE) with whom EIT has been entered

into

The rate at

which the

commissio

n or fee

has been

charged in

respect of the

transaction declared

Amount of

corporat e

guarante e

Name

Addres s

PAN, if

availabl e

Taxpayer

Identification

Number or its

equivalent in the

country/regio

n of location

Countr

y or

region in

which AE is

located (refer Note 7)

Credit

Ratin g

Rank

(refer Note 8)

Credit

Rating

Agenc

y (refer

Note 8)

A

B

C

D

E

F

G

H

I

J

1.

2.

(Repeat, if

required )

14

.

(i)

Nature of EIT:

Receipt of low value- adding intra-group services

(ii)

Whether the entire value of the international transaction including mark-up not exceeding 5% exceed ten crore rupees:

Yes/No

(iii

)

Certificate of the accountant as per rule 89(2) [Table: Sl. No. 8.C]

Upload as Annexure

(iv

)

Details of EIT:

Sl.

No

.

Details of the Associated Enterprise (AE) with whom

EIT has been entered into

Amount

of EIT

excludin

g mark- up

Mark -up

Amoun

t ofEIT

includi ng

mark- up

Details of certificate of

accountant

Name

Addres s

PAN, if

availabl e

Taxpayer

Identificatio

n Number or its

equivalent in the

country/regi

on of

Count

ry or

region in

which

AE is

locate d

Dat e

Unique

Identificati on

Number (UDIN)

location

(refer

Note 7)

A

B

C

D

E

F

G

H

I

J

K

1.

2.

(Repea

t, if

require

d)

IV. Eligible Specified Domestic Transaction (ESDT)

15

.

(i

)

Nature of ESDT:

Supply of electricity or transmission of electricity or wheeling of electricity

(ii)

Details of ESDT:

Sl.

No

.

Details of the Associated Enterprise

(AE) with whom ESDT has been

entered into

Details of relevant order of the Appropriate Commission determining the tariff or approving the methodology for determination of the tariff

Amount

received or

receivable /

paid or

payable in

respect of the ESDT

Name

Addres s

PAN

Date of order

Type of order

Validity of

order

A

B

C

D

E

F

G

H

1.

2.

(Repeat,

if

required)

16

.

(i)

Nature of ESDT:

Purchase of milk and milk products

(ii)

Details of ESDT:

The total amount of purchase for which safe harbour is opted

Whether the rate is —

Whether the rate of milk or milk

products are

routinely declared by the co-

operative society in a transparent manner and are available in

public domain (Yes/No)

Fixed on the basis of

quality –

SNF content – of milk

(Yes/No)

Irrespective of

milk procured (Yes/No)

Irrespectiv e of

percentage of shares

held by the members (Yes/No)

Irrespective

of the voting power held by the

members (Yes/No)

A

B

C

D

E

F

V. Eligible Business (EB)

17.

(i)

(a)

Nature ofEB (refer Note 9):

(b)

Details ofEB:

Gross

receipts

of the

eligible

business

Profit and gains of the EB chargeable to tax under the head “Profits and gains of business or profession” (shall be ≥ 4% of the gross receipts of the EB in the case of selling of raw diamonds and 2% of the gross receipts of the EB in the case of the business activity of storage of components in a warehouse in a custom bonded area for sale to a contract manufacturer)

The assessee understands and confirms that, —

No further deduction

under

section 28 to

34, 44 to 49, 51,52,

Schedule IX

and X has been

claimed

Written

down value

of assets is

deemed to

have been calculated

as if the

assessee

had claimed the

depreciation

No set off of

unabsorbed

depreciation under

section

33(11) or carried

forward

loss under section

112(1) has been

claimed

No set off of

loss from other

business

under section

108(1) or

other head

under section

109 has been claimed

A

B

C

D

E

F

Yes/No

Yes/No

Yes/No

Yes/No

(ii)

(Repeat, if required)

Verification

I, , on behalf of (name of eligible assessee) propose to opt for the safe harbour rules under section 167 read with rules 86 to 102. In this regard the particulars are as provided in Part A and B.

Also, I hereby affirm that the information provided above is true and correct to the best of my knowledge. I have not concealed any relevant fact. I am submitting this form in my capacity as (designation), holding PAN and I am competent to verify and submit this form.

Place:

Signature:

Date:

Name:

Designation:

Certification

I, , (Chief Executive Officer/Chairman and Managing Director of eligible assessee) certify that the information provided above is true and correct to the best of my knowledge. I have not concealed any relevant fact. I further certify the following (tick the relevant boxes):

The aggregate operating revenue of the eligible international transaction being provision of information technology services does not exceed two thousand crore rupees as specified in rule 89(2) [Table: Sl. No.

1.C]

Most of the economically significant functions are performed by the foreign principal as specified in rule 87(2)(a).

The foreign principal or its other associated enterprises provide funds or capital, other economically significant assets including intangibles required and the eligible assessee is only provided remuneration for the work carried out by it as specified in rule 87(2)(b).

Eligible assessee works under the direct supervision of the foreign principal or its associated enterprise as specified in rule 87(2)(c).

Eligible assessee has no ownership right, legal or economic, on any intangible generated or on the outcome of any intangible generated or arising during the course of rendering of services or on the outcome of the research, which vests with the foreign principal as specified in rule 87(2)(e).

Place:

Signature:

Date:

Name:

Designation:

(I)

Individual

(II)

Hindu undivided family

(III)

Company

(IV)

Firm

(V)

Association of Persons or Body of individuals, whether incorporated or not

(VI)

Local authority

(VII)

Artificial Juridical Person

(VIII)

Government

(IX)

Trust

(X)

Limited Liability Partnership

(I)

Provision of contract research and development services wholly or partly relating to generic pharmaceutical drugs.

(II)

Manufacturing and export of core auto components.

(III)

Manufacturing and export of non-core auto components.

(IV)

Provision of the data centre services.

(I)

Selling of raw diamonds.

(II)

The business activity of storage of components in a warehouse in a custom bonded area for sale to a contract manufacturer.