Form for filing particulars of past years for calculating relief in tax payable under section 206(1).

Part A: Particulars ofthe Person

1.

Name:

(refer Note 1)

2.

Address:

(refer Note 2)

3.

Communication Address in India:

(refer Note 3)

4.

Permanent Account Number (PAN):

5.

Aadhaar Number:

6.

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

7.

E-mail Id:

8.

Contact Number:

Country

Code

Number

9.

Authorised Representative (if applicable):

(refer Note 4)

Part B: Other Details

10.

Residential status of the company:

11.

Relevant Tax Year

12.

Is it a case of Advance Pricing Agreement (APA) or secondary adjustment:

13.

Details of past income (refer rule 118(3)):

Relevant Tax year

Amount of past income

Total amount of past income

14.

Amount A of formula in rule 118(1) (tax payable on book profit of the tax year including past income):

15.

Amount B of formula in rule 118(1) (tax payable on book profit of the tax year excluding past income):

16.

(A-B) [(14) – (15)]:

17.

(a)

Amount C of formula in rule 118(1):

(b)

Amount of tax payable

Aggregate of tax payable on the book profit of past years

including past income

Relevant tax year

Details of tax

payable on the book profit of past years including past

income:

Relevant tax year

18.

(a)

Amount D of formula in rule 118(1):

(b)

Details of tax payable on the book profit of past years:

Relevant tax year

Amount of tax payable

Aggregate of tax

payable on the book profit of the past

years

19.

(C-D) [(17)(a) – (18)(a)]:

20.

Relief in tax under section 206 [(16) – (19)] (enter zero, if negative):

Verification

I, , holding PAN 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.