FORM NO.

15CA Acknowledgement
[See rule 37BB] Number
Information to be furnished for payments, to a non-
354845431180521
resident not being a company, or to a foreign company
x
PART A - To be filled up if the remittance is chargeable to tax under the provisions of the Income-tax Act,1961 and
the remittance or the aggregate of such remittances, as the case may be, does not exceed five lakh rupees during the
financial year.
PART B - To be filled up if the remittance is chargeable to tax under the provisions of the Income-tax Act,1961 and
the remittance or the aggregate of such remittances, as the case may be, exceeds five lakh rupees during the financial
year and an order/ certificate u/s 195(2)/ 195(3)/ 197 of Income-tax Act has been obtained from the Assessing Officer.
PART C - To be filled up if the remittance is chargeable to tax under the provisions of Income-tax Act, 1961 and the
remittance or the aggregate of such remittances, as the case may be, exceeds five lakh rupees during the financial year
and a certificate in Form No. 15CB from an accountant as defined in the Explanation below sub-section (2) of section
288 has been obtained.
PART D - To be filled up if the remittance is not chargeable to tax under the provisions of the Income-tax Act,1961
{other than payments referred to in rule 37BB(3)} by the person referred to in rule 37BB(2).
x
Please select the relevant part from the drop down. PART - C
x
PART - C
Acknowledgement No of 15CB 354837731180521
PART C - Section A
To be filled up if the remittance is chargeable to tax under the provisions of Income-tax Act, 1961 and the remittance
or the aggregate of such remittances, as the case may be, exceeds five lakh rupees during the financial year and a
certificate in Form No. 15CB from an accountant as defined in the Explanation below sub-section (2) of section 288
has been obtained
Section A - GENERAL INFORMATION
REMITTER
Name of Remitter CODOGNOTTO LOGISTICS INDIA PVT LTD
PAN of Remitter AACCI4936L
TAN of the Remitter
Area Code
AO Type
Range Code
AO Number
Principal Place of Business INDIA
ADDRESS OF THE REMITTER
Flat/ Door/ Building NO.203, 2ND FLOOR, NO.20,
Name of premises/ Building/ Village AMAR REGENCY LAYOUT
Road/ Street ABOVE HDFC BANK, HORAMAVU MAIN ROAD
Area/ Locality BANGALORE NORTH
Town/ City/ District BANGALORE
State KARNATAKA
Country INDIA
Pin Code 560043
Email ID [email protected]
Phone Number 8049032000
Status COMPANY
Residential status of remitter Domestic company
REMITTEE
Name of recipient of remittance SHIPAIR EXPRESS (HK) LTD
PAN of recipient of remittance
Status COMPANY
ADDRESS OF THE RECIPIENT OF REMITTANCE
Flat/ Door/ Building UNIT 1504-7
Name of premises/ Building/ Village TELFORD HOUSE
Road/ Street 16 WANG HOI ROAD
Area/ Locality KOWLOON BAY
Town/ City/ District KOWLOON
State HONG KONG
Country HONGKONG
ZIP Code 999999
Country to which remittance is made HONGKONG
Principal Place of Business HONG KONG
Email Address
(ISD code)-Phone Number
ACCOUNTANT
(a) Name of the Accountant signing the certificate MANOJ MAHIMKAR
(b) Name of the proprietorship/firm of the MDM & CO.
accountant
(c) ADDRESS OF THE ACCOUNTANT
Flat/ Door/ Building 403
Name of premises/ Building/ Village CRESCENT BUSINESS SQUARE
Road/ Street KHERANI ROAD, NEAR SAKINAKA METRO STATION
Area/ Locality SAKINAKA, ANDHERI EAST
Town/ City/ District MUMBAI
State MAHARASHTRA
Country INDIA
Pin Code 400072
(d) Registration no. of the accountant 048883
(e) Date of certificate (DD/MM/YYYY) 18/05/2021
(f) Certificate No 354837731180521
A.O. ORDER
(a) Whether any order/ certificate u/s 195(2)/ No
195(3)/ 197 of Income-tax Act has been obtained
from the Assessing Officer.
(b) Section under which order/certificate has been
obtained.
(c) Name of the Assessing Officer who issued the
order/certificate.
(d) Designation of the Assessing Officer who
issued the order/certificate.
(e) Date of order/certificate (DD/MM/YYYY).
(f) Order/ certificate number.
PART C - Section B
Section B - PARTICULARS OF REMITTANCE AND TDS (as per certificate of the accountant)
REMITTANCE
1. Country to which remittance is made.
Country HONGKONG
Name of Country if selected as Others
Currency US DOLLAR
Currency if selected as Others
2. Amount payable.
In foreign currency 25220.81
In Indian Rs 1840884
3. Name of bank HDFC Bank Ltd
Name of bank if selected as Other Bank
Branch of the bank RICHMOND CIRCLE, LALBAGH ROAD
4. BSR code of the bank branch (7 digit) 0510010
5. Proposed date of remittance 18/05/2021
6. Nature of remittance as per agreement/ OTHER INCOME / OTHER (NOT IN THE NATURE OF INCOME)
document
Nature of remittance as per agreement/ document REIMBURSEMENT OF FREIGHT CUSTOM AND PORT HANDLIN
if selected as Others G CHARGES
Relevant purpose code as per RBI Transport
 S0217 - Other payments by Shipping companies
8. In case the remittance is net of taxes, whether No
tax payable has been grossed up?
I.T.AC T
9. Taxability under the provisions of the Income-tax Act (without considering DTAA).
(a) the relevant section of the Act under which the
remittance is covered
(b) the amount of income chargeable to tax
(c) the tax liability
(d) basis of determining taxable income and tax
liability
DTAA
10. If any relief is claimed under DTAA -
(i) Whether tax residency certificate is obtained Yes
from the recipient of remittance
(ii) please specify relevant DTAA
(iii) please specify relevant article of DTAA
(iv) taxable income as per DTAA (In Indian Rs.)
(v) tax liability as per DTAA (In Indian Rs.)
A. If the remittance is for royalties, fee for No
technical services, interest, dividend, etc,(not
connected with permanent establishment) please
indicate:-
(a) Article of DTAA
(b) Rate of TDS required to be deducted in terms
of such article of the applicable DTAA
B. In case the remittance is on account of business No
income, please indicate:-
(a) The amount of income liable to tax in India
(b) The basis of arriving at the rate of deduction of
tax.
C. In case the remittance is on account of capital No
gains, please indicate:-
(a) amount of long term capital gains
(b) amount of short-term capital gains
(c) basis of arriving at taxable income
D. In case of other remittance not covered by sub- Yes
items A, B and C
(a) Please specify nature of remittance REIMBURSEMENT OF FREIGHT CUSTOM AND PORT HANDLIN
G CHARGES
(b) Whether taxable in India as per DTAA No
(c) If yes, rate of TDS required to be deducted in
terms of such article of the applicable DTAA
(d) if not, please furnish brief reasons thereof REIMBURSEMENT OF FREIGHT CUSTOM AND PORT HANDLIN
specifying relevant article of DTAA G CHARGES
TDS
11. Amount of tax deducted at source
In foreign currency 0
In Indian Rs 0
12. Rate of TDS
13. Actual amount of remittance after TDS (In 25220.81
foreign currency)
14. Date of deduction of tax at source, if any (DD/
MM/YYYY)

PART-C VERIFICATION
1. I, HEMA SRINIVASAN(Name in full and in block letters) son/daughter/wife of BALAN RAMAN in the capacity of
DIRECTOR (designation) solemnly declare that the information given above is true to the best of my knowledge and
belief and no relevant information has been concealed.

2. I certify that a certificate has been obtained from an accountant, particulars of which are given in this Form, certifying
the amount, nature and correctness of deduction of tax at source.

3. In case where it is found that the tax actually deductible on the amount of remittance has not been deducted or after
deduction has not been paid or not paid in full, I undertake to pay the amount of tax not deducted or not paid, as the
case may be along with interest due. I shall also be subject to the provisions of penalty for the said default as per the
provisions of the Income-tax Act, 1961.

4. I further undertake to submit the requisite documents for enabling the Income-tax Authorities to determine the nature
and amount of income of the recipient of the above remittance as well as documents required for determining my liability
under the Income-tax Act, 1961 as a person responsible for deduction of tax at source.

Date (DD/MM/YYYY): 18/05/2021

Name of the person responsible for paying to non-resident HEMA SRINIVASAN

Place BENGALURU

Designation DIRECTOR
This form has been digitally signed by HEMALATHA BALAN having PAN BBWPS8826C from IP Address
103.44.49.219 on 2021-05-18 14:52:06.0 .
Dsc Sl No and issuer 2833980831083704351CN=SafeScrypt sub-CA for RCAI Class3 2014,OU=Sub-CA,O=Sify
Technologies Limited,C=IN