Statement of income paid or credited by a securitisation trust to be furnished under section 221

Part A: Particulars of the Securitisation Trust

1.

Name:

(refer Note 1)

2.

Address:

(refer Note 2)

3.

Permanent Account Number (PAN):

4.

Legal Status:

(refer Note 3)

5.

E-mail Id:

6.

Contact Number:

Countr

y Code

Country

Code

Part B: Other Information

7.

Tax Year:

8.

Details of the Directors or Partners or Trustees of the securitisation trust:

S

l.

N

o

.

Name

PAN

Aadh

aar

Address

Contact

Number

E-mail Id

Designation

1

.

2

.

(Repeat, if

required)

9.

Details of the Status and the Registration of securitisation trust:

Act/ Regulations under which registered

Status of

Securitisation Trust

Date of registration

Registration Number

Validity of

registration (up to)

10.

(i)

Income of the securitisation trust under the head ‘Income from house property‘ [A]:

(ii)

Proportion to [E] (in %):

11.

(i)

Income of the securitisation trust under the head ‘Profits and gains of business or profession‘ [B]:

(ii)

Proportion to [E] (in %):

12.

Income of the securitisation trust under the head ‘Capital Gains‘ [C]:

(i)

Long Term Capital Gain:

(a)

(I)

Capital Gains Code (refer Note 4):

(II)

Amount:

(III)

Proportion to [E] (in %):

(b)

(Repeat, if required,for the multiple capital gains code)

(ii)

Short Term Capital Gain:

(a)

(I)

Capital Gains Code (refer Note 3):

(II)

Amount:

(III)

Proportion to [E] (in %):

(b)

(Repeat, if required,for the multiple capital gains code)

13.

Income of the securitisation trust under the head ‘Income from other sources‘ (in ₹) [D]:

(i)

(a)

Dividends:

(b)

Proportion to [E] (in %):

(ii)

(a)

Others:

(b)

Proportion to [E] (in %):

14.

Total income of the securitisation trust [E] = [A] + [B] + [C] + [D]:

15.

Details of persons, referred to in section 221(1) by whom the income is received or in whose name it has been credited or deemed to have been credited, in the following format:

Sl. No.

Name

of the

investor

Addre ss

PAN/

Aadh aar

Total

amou nt

paid/

credit ed/

deem

ed to be

credit ed

Date of

paym ent/ credit

Inco me

under the

head

‘Inco me

from

house

prope rty‘

Inco me unde

r the

head

‘Prof its

and gains of

busin ess

or

profe

ssion ‘

Income under the head ‘Capital Gains‘

Income

under the head

‘Income

from other

sources‘ [D]:

Long Term Capital Gain

Short Term Capital Gain

Divid end

Oth

ers

Capita l

Gains

Code

(refer Note 4)

Incom e

Ca

pita l

Gai ns Co

de

(ref er Not

e 4)

Incom e

(1)

(2)

(3)

(4)

(5)

(6)

(7) =

(5) × Sl.

No.

10(ii)

(8) =

(5) × Sl.

No.

11(ii)

(9) =

releva nt

codes

at Sl. No.

12(i)

(10) =

(5) ×

Sl. No. 12(i)

(propo rtion

to [E] for

each

capital gains code)

(11

) =

rele

van t

cod es at Sl.

No.

12(

ii)

(12) =

(5) ×

Sl. No.

12(ii)

(propo rtion

to [E] for

each

capital gains code)

(13)

= (5)

× Sl. No.

13(i)( b)

(14) =

(5) × Sl.

No.

13(i

i)(b )

1.

2.

(Repeat, if required, for each name and capital gains code as well)

1

6.

Other details to be provided as separate enclosure:

(attach as per Note

5)

Declaration

I, , hereby declare 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.

Place: Signature:

Date: Name:

Designation:

Verification

I have examined the books of account and other documents showing the particulars of income earned and the income distributed / credited (including amount deemed to have been credited in accordance with provisions of section 221(3)) to the investors by the (name of the securitisation trust for the tax year ending

.

__________________

I declare that the above particulars are true and correct to the best of my knowledge and belief.

Place: Signature:

Date: Name of the accountant:

Designation:

Membership Number:

UDIN, if any:

Name of the Proprietorship/Firm:

Firm Registration Number:

(I)

Company

(II)

Trust

(III)

Limited Liability Partnership

(IV)

Body Corporate

Sl.

No.

Capital Gains

Code

1.

Long term capital gain chargeable at 12.5% under section 198

1

2.

Long term capital gain chargeable at 12.5% under section other than section 198

2

3.

Long term capital gain chargeable at 20%

3

4.

Short term capital gain chargeable at 20% under section 196

4

5.

Short term capital gain chargeable at 30%

5

6.

Short term capital gain chargeable at applicable rates

6

Annexure

. .

Particulars

A-1

A copy of the certificate of registration under the applicable Act or Regulations, viz., in case of securitisation trust, under the Securities and Exchange Board of India (Public Offer and Listing of Securities Debt Instruments) Regulations, 2008 made under the Securities and Exchange Board of India Act, 1992 (15 of 1992); in case of Special Purpose Vehicle regulated by the guidelines of Standard Assets issued by the Reserve Bank of India; and in case of Securitisation Company or a Reconstruction Company, under the Securitisation and Reconstruction of Financial Assets and Enforcement of Security Interest Act, 2002 (54 of 2002).

A-2

Audited accounts including balance sheet, annual report, if any, with certified copies of income and appropriation towards payment of income or credit of income (including amount deemed to have been credited in accordance with provisions of section 221(3)).