Statement of income of a specified fund eligible for concessional taxation under section 210(2) of the Act

Part – A

1.

Details of the specified Fund

)

Name

(refer note 1)

(ii)

Address of the registered office

(refer note 2)

(iii)

Permanent Account Number

(iv)

Email ID

(v)

Contact number

Country Code

(vi)

Legal status

(select one)

1. company

2. trust

3. limited liability partnership

4. body corporate

(vii

Registration number as per the cer- tificate of registration issued by the International Financial Services

Centre Authority

(vii

Date of registration:

dd/mm/yyyy

(ix)

Please upload a copy of the certifi- cate of registration

UPLOAD

2.

Tax year ending

dd/mm/yyyy

3.

Total income of specified fund during tax year

Part -B

Details of income of specified fund attributable to non-residents and eligible for concessional taxation un-

der section 210(2)

Sl.No.

Income or Loss of the specified fund

Amount

Income attributable to units

held by non-resident (not being

a permanent establishment of a

non-resident in India)

4.

Income from securities as referred to in

section 210(1) [Table: Sl. No.1] (Annexure 1)

Total of Column (5) in Annexure 1

Total of Column (9) in Annex-

ure 1

5.

Income from Short Term Capital Gain

arising from transfer of securities as re-

ferred to in section 210(1)[Table: Sl. No.2] (Part B1)

Total of Column

(5) in Part B1 of

Annexure 2

Total of Column (9) in Part B1 of

Annexure 2

6.

Income from Short Term Capital Gain

arising from transfer of securities as re-

ferred to in section 210(1)[Table: Sl. No.3] (Part B2)

Total of Column

(5) in Part B2 of

Annexure 2

Total of Column (9) in Part B2 of

Annexure 2

7.

Income from Long Term Capital Gain as referred to in section 210(1)[Table: Sl.

No.4] (Part B3)

Total of Column

(5) in Part B3 of

Annexure 2

Total of Column (9) in Part B3 of

Annexure 2

8.

Income from Long Term Capital Gain as referred to in section 210(1)[Table: Sl.

No.5] (Part B4)

Total of Column

(5) in Part B4 of

Annexure 2

Total of Column (9) in Part B4 of

Annexure 2

Declaration

I (name), holding Permanent Account Number , do hereby affirm that the conditions stipulated in Note 1(g)(i) in Schedule VI to the Act are satisfied by the specified fund.

I do hereby declare that to the best of my knowledge and belief what is stated above and, in the Annexure(s) is correct and complete. I further declare that I am furnishing such statement in my capacity as  (designation) and that I am competent to make this declaration and furnish this statement.

Place:

Date:

Signature … … … ….. … … … … … …. Name   Designation … … … … … … … … … …

S.

No.

Name

of se-

curity

Nature

of In-

come

(select one)

Date of

receipt of income

(dd/mm/yy yy)

In-

come (in

Rs.)

Assets un-

der man- agement

held by

non- resi-

dent unit- holders

(not being

the permanent establish-

ment of a

non- resi-

dent in

India) as

on the

date of re-

ceipt of

income

Total as-

set Under manage- ment as

on the

date of

receipt of income.

Ratio

Income

attributa- ble to

units held by non-

resident

(not being a perma- nent estab-

lishment of

a non- res- ident in

India) (in Rs.)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)=

(6)/( 7)

(9) =

(5)×(8)

Income from securities as referred to in section 210(1) [Table: Sl. No.1]

1.

1.Divide nd

2. Inter- est

3. Others, please

specify

Repeat, if required

To-

tal

S.

No.

Nam

e of

secu- rity

Date of acquisi-

tion

(dd/mm/yy yy)

Date of transfer

(dd/mm/yy yy)

Cap- ital Gain

Aggregate

of daily ‘assets

under

manage-

ment‘ of

the speci-

fied fund

held by non-

resident

unit hold-

ers (not

being the

permanent

establish-

ment of a

non- resi- dent in India)

from the

date of acquisi-

tion of the

security to

the date of

transfer of

such secu- rity

Aggre-

gate of

daily to-

tal ‘assets under

manage-

ment‘ of

the speci-

fied fund,

from the

date of acquisi-

tion of

the secu-

rity to

the date

of trans-

fer of

such se- curity.

Ra-

tio

Income attributa-

ble to

units held

by non- resident

(not be-

ing a perma-

nent es- tablish-

ment of a

non- res-

ident in India)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)=

(6)/( 7)

(9) =

(5)×(8)

Part B1 Income from short term capital gain as referred to in section 210(1)[Table: Sl. No.2]

1.

2.

To-

tal

Part B2. Income from short term capital gain as referred to in section 210(1)[Table: Sl. No.3]

1.

2.

To-

tal

Part B3. Income from long term capital gain as referred to in section 210(1)[Table: Sl. No.4]

1.

2.

To-

tal

Part B4. Income from long term capital gain as referred to in section 210(1)[Table: Sl. No.5]

1.

2.

Total