FORM NO.
30C
[See rule 43]
Form for furnishing the details under section 230(1A) of the Income Tax Act, 1961
To
Income Tax
1. Full name (in Block letters) : <<PLEASE INSERT>>
2. Present Address : <<PLEASE INSERT>>
3. Permanent Address : <<PLEASE INSERT>>
4. Name of father: <<PLEASE INSERT>>
5. Nature of business/ profession in India : <<PLEASE INSERT>>
6. *The PAN allotted under section 139A : <<PLEASE INSERT>>
Sir,
I give below the necessary particulars as required under sub-section (1A) of section 230:
Or
*My total income is not chargeable to income-tax (certificates as per annexure)
7. The purpose of visit outside India: <<PLEASE INSERT>>
8. Estimated period of stay outside India : <<PLEASE INSERT>>
9. Passport No./ Emergency Certificate No. <<PLEASE INSERT>>
(a) Issued on (date) : <<PLEASE INSERT>>
(b) From (Place) : <<PLEASE INSERT>>
Or
*I am not required to obtain a PAN under the Income-tax Act, 1961 (certificate as per annexure)
I declare that to the best of my knowledge and belief, the information furnished is correct and truly
stated.
Place : <<PLEASE INSERT>> Yours Faithfully
Date : <<PLEASE INSERT>>
X_____________________
<<PLEASE INSERT>>
Applicant
*Delete whichever is not applicable
ANNEXURE
Certificate to be furnished by a person domiciled in India whose total income is not chargeable
to income-tax or who is not required to obtain a PAN under the Income-tax Act
I ______________________ *son/ daughter/ wife of __________________ resident of
___________________ do hereby certify that:
(a) *No permanent account number has been allotted to me under the provisions of section
139A of the Income-tax Act, 1961;
OR
(b) *My
1961,total income computed in accordance with the provisions of the Income-tax Act,
Is not chargeable to tax;
OR
(c) *I am not required to obtain a permanent account number under the provisions of Income-
Tax Act, 1961
.
_____________________________
(Signature of the person giving the certificate)
Name (in Block letters):
Address ______________________________
VERIFICATION
I <<PLEASE INSERT>> do hereby certify that to the best of my knowledge and belief what is stated
above is correct and truly stated.
Verified today the __ day of _________________
Place: X
_____________________________
(Signature of the person giving the certificate)
Name (in Block letters):
Address ______________________________
______________________________
* Delete whichever is not applicable