Form for furnishing information under section 258(2) of the Act.

To Date:

__________________________________________

__________________________________________

__________________________________________

(A) With reference to your application dated under section 258(2)(a) of the Act, re- questing for information relating to the (name of assessee) in respect of the tax year , the said information/information respecting item Nos. of the said application is given below:

Part A – Personal information of the assessee

1.

Name

(Refer Note 1)

2.

Permanent Account Number

(Refer Note 1)

3.

Status

(Refer Note 1)

4.

Address

(Refer Note 1)

5.

Contact details

(i)

Landline No. with STD code

STD/ISD

Code

Number

(dropdown)

(Repeat, if required)

(ii)

Mobile Number

Country

Code

Number

(dropdown)

(Repeat, if required)

(iii)

Email Address

(Repeat, if required)

Part B – Information details

6.

Information details

(Refer Note 2)

(Free text up to 500 words)

(Upload)

(B) I/ Principal Chief Commissioner or Chief Commissioner or Principal Commissioner or Commis- sioner of Income-tax*, am/is not satisfied that it is in the public interest to furnish information respecting item Nos. of your application and the information relat- ing thereto is accordingly refused.

(SEAL)

Signature of the authority furnishing the information (Name of the authority furnishing the information)

Designation of the authority furnishing the information