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Form No. 64C: (In RS.)

This document is a statement of income distributed by an investment fund to a unit holder. It includes: 1) Details of the unit holder such as name, address, and PAN or Aadhaar number. 2) Details of the investment fund such as name, address, and PAN or Aadhaar number. 3) A table showing the amounts paid or credited to the unit holder from the investment fund during the previous year, broken down by head of income and date.

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1K views1 page

Form No. 64C: (In RS.)

This document is a statement of income distributed by an investment fund to a unit holder. It includes: 1) Details of the unit holder such as name, address, and PAN or Aadhaar number. 2) Details of the investment fund such as name, address, and PAN or Aadhaar number. 3) A table showing the amounts paid or credited to the unit holder from the investment fund during the previous year, broken down by head of income and date.

Uploaded by

busuuu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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FORM NO.

64C
[See rule 12CB(1)(i)]
Statement of income distributed by an investment fund to be provided to the unit holder under
section 115UB of the Income-tax Act, 1961
1. Name of the unit holder:
2. Address of the unit holder:
3. Permanent Account Number or Aadhaar Number] of the unit holder:
4. Previous year ending:
5. Name and address of the Investment Fund:
6. Permanent Account Number or Aadhaar Number] of the Investment Fund:
7. Details of the income paid or credited by the Investment Fund to the unit holder during the
previous year:
(In Rs.)
Sl. Amount Date of Breakup of Amount paid/credited under Heads of Income
No. paid or payment
credited or credit

‘Business ‘Long Term ‘Gain’ Short Term Other Sources’


Capital Capital Gain’
and
Profession’

Referred Others To Others ‘Dividend’ Others


to in which [referred
section section to in
10(38) 111A section
applies 115-O]

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

I ,
................................................................................................................................................................
(Name in full and in block letters)
son/daughter/wife of ........................................................................................................... do hereby
solemnly declare that to the best of my knowledge and belief what is stated above and in the
Annexure(s), including the documents accompanying such 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 furnish this statement and verify it.

Verified today the .......................................... day of .........................


Place ...........................
Signature
............................................

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