Intimation by a constituent entity, resident in India, of an international group, the parent entity of which is not resident in India, for the purposes of section 511(1)

Part A: Particulars ofthe Constituent Entity

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: Other Information

6.

Name of the international group of which the assessee is a constituent entity:

(refer Note 1)

7.

Details of the parent entity of the international group:

(refer Note 1)

Name (refer Note 1)

Address (refer Note 2)

Country of residence

8.

Whether the international group has designated an alternate reporting entity in place of the parent entity to furnish the report referred to in section 511(2). If Yes, then provide the following details of the alternate reporting entity:

Name (refer Note 1)

Address (refer Note 2)

Country of residence

9.

Reportable Accounting Year:

Verification

I, , 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.

I am submitting this application in my capacity as (designation), holding PAN and I

am competent to verify and submit this application.