Form for opting for taxation of income by way of royalty in respect of patent

Part A: Particulars of the assessee

1.

Name of the assessee

(refer Note 1)

2.

Address

(refer Note 2)

3.

Permanent Account Number

4.

Residential Status

(refer Note 3)

5.

Email id

6.

Contact number

Country Code

Number

7.

Tax year

(refer Note 4)

8.

Nature of business or activities of the assessee

Part B: Particulars of tax year

1.

(a) Whether the option for offering the income by way of royalty in respect of a patent as per section 194(1) [Table: Sl. No. 2] is to be exercised for the tax year?

(Yes/No)

(b) Whether the return of income for the tax year has been filed?

(Yes/No)

(c) If answer to (b) above is “Yes”, please furnish date of filing of return of income (if filed already)

(dd/mm/yyyy)

2.

(a) Whether income by way of royalty in respect of a patent as per section 194(1) [Table: Sl. No. 2] is not offered for taxation as per the said section for any of the five tax years succeeding the tax year in which the option for taxation of such income is first validly exercised.

(Yes/No)

(b) If answer to (a) above is Yes, provide the following details:

Tax year in which the option for taxation of income by way of royalty under section 194(1) [Table: Sl. No. 2] is first valid- ly exercised

Date of furnishing of return of income for the tax year men- tioned in column (A)

(dd/mm/yyyy)

Tax year in which such income is not of- fered to tax in accordance with the provi- sions of section 194(1) [Table: Sl. No. 2]

(A)

(B)

(C)

PART C: Particulars of Eligible Patent (refer Note 5)

1.

Patent Details

(a) Patent Number granted under the Patents Act, 1970 (39 of 1970)

(b) Date of grant of patent under the Patents Act, 1970 (39 of 1970)

(dd/mm/yyyy)

(c) Description of the patent developed and regis- tered in India containing the invention, patent article and patent process as detailed out in section 2 of the Patents Act, 1970 (39 of 1970)

(refer Note 6)

(d)Whether the patent is granted to single person

Yes/No

(e) If answer to (d) above is Yes, please furnish de- tails of patentee being the true and first inventor as entered in patent register.

Name

Permanent Ac-

count Number

Address

(f) If answer to (d) above is No, please furnish de- tails ofthe patentees ofthe patent (patentee being

Sl.

No.

Name

Permanent Ac-

count Number

Address

the true and first inventor as entered in patent regis- ter)

2.

Details of Royalty Income from eligible patent

(a) Amount of royalty income from eligible patent for the tax year

(b) Nature of royalty income derived from the eligi- ble patent for the tax year as referred to in section 194(2)(l)

(select anyone)

o (i) transfer of all or any rights (including the granting of a license) in respect of patent

o (ii) imparting of any information concerning the working of, or the use of, a patent

o (iii) use of any patent

o (iv) rendering of any services in connection with the activities referred to in sub-clauses(i) to (iii)

3.

Details of Expenditure incurred on eligible patent

(a) Please furnish details in respect of expenditure incurred by the assessee on the patent for any invention in respect of which patent is granted under the Patents Act, 1970 (39 of 1970)

(i) Total expenditure incurred

(ii) Expenditure incurred in India

(iii) Expenditure incurred outside India

(b) Whether the expenditure incurred in a(ii) above is seventy five percent or more than the expenditure incurred under (a)(i) above?

Yes/No