FORM NO. ISG [See section 197A(1), IUTAU A) and rule 29C] ny an individual or a person (nm ion of tax, Dectara being, T, Name of Asses [Deckirant) 2. PAN of the Assessce™ ‘Le pay Sevveel. A _|__ Arne P).03654, Tate 4 Prviow yar ¥)" 2024 ~2026 | 5 Residential Siwy i | | Lat Divs Dus ___| (for which declaration is being, made) © MavfDoor Block No] 7 Name of Premises 4, Road/SireeULane 9 Area/Localiy | 1b THY DEVAL PALL! WIC: WeeeennsiDL 10 Towa/Ciybustrial | 11. Sta 12, Pint |_THEal! __| TamiLnady. A265 Sy. TH Telephone No, (wih STD. | 15 (a) Whether assessed to tax under the Yes No Code) and Mobile No. Income-tax Act, 1961": oO x WR IKE B25 (oye, nest asessrent yar for which asses 16. Estimated income for which this dectara 17, Eslimated total income of the P.Y, ia which incorne mentioned in column 16 to be included 100,000 150000 TE, Details of Form No, 15G ober than tis form filed during he previous year, any’ “Toial No. of Form No, 15G fied ‘Regregate amount of income for which Foun No.15G Wied 19, Daily of wicomne for which the declaration iy Aled Sl | Héentification number of relevant | Nature ofincome | Seclion under which tax | Amount of income No, | investment/account, etc is deductible. T|baws 101230196015 | FRE 192 (a) _[n0680p | “Signature of thé Declarant? DEEP EB SEL art A Declaration/Verification'® swe lo hereby declare that to the best of tmyfour knowledge and belief what is stated above is correct, ‘complete and is uly stated, "I/We declare that the incomes referred to in this form are not includible in the otal income of any other person under sections 6 to 64 of the Income-tex Act, 1961, *W/We further dclare tat thet *on myfour estimated el inconeinluding ¥incomelineomes refered to i column 16 "and fgeregate amount of Fincomefincomes referred io in eoluinn | 8 conn accordnee with the provisions of Te nar eat andy ow SUMNARCH CLEA toe sesment yr 026-302 be nil. “I/We also declare that *my/our *income/incomes referred to in column 16 *and the aggregete amount of “ingen pone ferred to in colurnn 18 for the previous year ending ond marci Seebat to ibe assessment year2$ Sift not excoed the snaximum «mount which is not chargeable to income-t2x. Place: .. CHEEAL. Date: Lo DF. 2024. ofthe Declarant’ a (A H00 t0 tnd PART II [To be filled by the person responsible for paying the income referred to in column 16 of Part I] T. Name of te person responsible for paying 2. Unique Identification No!” 3 PAN of the person | 4 Complete Address 3. TAN of the person responsible for paying responsible for paying 6. Email 7. Telephane No. (with STD Code) and Mobile No. | 8. Amount of income paid” 3. Dale on which Declaration 6 received | 16. Date on which the income has been paid/eredited (DDIMMIYYYY) i (DDINMIYYYY) Place = . Signature ofthe person responsible for paying Date... 7 . the income referred to in column 16 of Part I @ scanned with OKEN Scanner*Deleie whichever is not applicable "As per provisions of section 206.A(2), the declaration under section 197A(I) oF 197A(LA) shall be invalid iF the declarant fails to fumish his vatid Permanent Account Number (PAN) Declaration ean be fumished by an individual under section 197A(1) and a person (other than a company or a firm) under section 197A). “The financial yearto which the income pertains ‘ease mention the residential status as per the provisions of section 6 of the Income-tax Aci, I * Please mention “Yes” if assessed (0 tax under the provisions of Income-tax Act, 1961 for any Of the assessment year out of six assessment years preceding the year in which the declaration is filed. ‘Please mention the amount of estimated tolal income of the previous year for which the declaration is filed including the amount of income for which this declaration is made. In case any declaration(s) in Form No. 15Gis filed before filing this declaration during the previous year, mention the total number of such Form No, 15G filed along with the aggregate amount of income for which said dcclaration(s) have been filed, ‘Mention the distinctive number of shares, account number of term deposit, recurring deposit, National Savings ‘Schemes, life insurance policy number, employee code, etc. “indicate the capacity in which the declaration is furnished on behalf ofa HUF. AOP, ete. "Before signing the declaration/verification, the declarant should satisfy himself that the information furnished in this form is truc, correct and complete in all respects, Any person making a false statement in the declaration shall be liable to prosecution under section 277 of the Income-tex Act, 1961 and on conviction be punishable- (i in a case where tax sought to be evaded exceeds twenty-five lakh rupees, with rigorous imprisonment ‘which shall not be less than six months but which may extend to seven years and with Ge; (i) in any other case, with rigorous imprisonment which shall not be less than tres months but which may extend to two years and with fine The person responsible for paying the income referred to in column 16 of Past I shall allot a unique identification number to all the Form No. 15G received by him during a quarter of the financial year and report this reference ‘number along with the particulars prescribed in rule 31A(4)(vii) of the Income-tax Rules, 1962 in the TDS statement furnished for the same quarter. In case the person has also received Form No.15H during the same quarter, plcasc allot separate series of serial number for Form No.15G and Form No.15H. “The person responsible for paying the income referred to in column 16 of Part | shall not accept the declaration where the amount of income of the nature referred to in sub-section (1) or sub-section (1A) of section 197A or the aggregate of the amounts of such income credited or paid or likely to be credited or paid during the previous year in which such income is to be included exceeds the maximum arnount which is not chargeable to lax. For deciding the cligibility, he is required to verify i declarant in columns 16 and 18.: @ scanned with OKEN Scanner