Name of the Company Dp. Id – Client Id/ Folio No.

INCOME-TAX RULES, 1962

1
FORM NO. 15G
[See section 197A(1), 197A(1A) and rule 29C]
Declaration under section 197A(1) and section 197A(1A) to be made by an
individual or a person (not being a company or firm) claiming certain
incomes without deduction of tax
PARTI
1. Name of Assessee (Declarant) 2. PAN of the Assessee1
2
3. Status 4. Previous year (P.Y.)3 5. ResidentialStatus4
(for which declaration is being made)
6. Flat/Door/Block 7. Name of 8. Road/Street/Lane 9. Area/Locality
No. Premises
10. Town/City/District 11. State 12. PIN 13. Email

14. Telephone No. (with 15. (a) Whether assessed to Yes No

STD Code) and tax under the Income-tax
Mobile No. Act,19615
(b) If yes, latest assessment
year for which assessed
16. Estimated income for which this 17. Estimated total income of the P.Y. in
declaration is made which income6 mentioned in column16
to be included
18. Details of Form No.15G other than this form filed during the previous year, if any7
Total No. of Form No.15G Aggregate amount of income for which Form
filed No.15G filed

19. Details of income for which the declaration is filed

Identification number of Section under Amount of

Sl. relevant investment/account, Nature of income which tax is income
No. deductible
etc8

………….

…………….……………………
Signature of the Declarant 9
 Declaration/Verification 10

*I/We...............................................................do hereby declare that to the best of *my /our

knowledge and belief what is stated above is correct, complete and is truly stated. *I/We declare
that the incomes referred to in this form are not includible in the total income of any other
person under sections 60 to 64 of the Income-tax Act, 1961. *I/We further declare that the tax
*on my/our estimated total income including *income/incomes referred to in column 16 *and
aggregate amount of *income/incomes referred to in column 18 computed in accordance with
the provisions of the Income-tax Act,1961, for the previous year ending on 31-MAR-2021.
relevant to the assessment year 2021-2022.will be nil. *I/We also declare that *my/our
*income/incomes referred to in column16 *and the aggregate amount of *income/incomes
referred to in column 18 for the previous year ending on 31-MAR-2021. relevant to the
assessment year 2021-2022 will not exceed the maximum amount which is not charge-able to
income-tax.

Place:…………………….. ……………………………
Date:........................................ Signature of the Declarant9

______________
1. Substituted by IT (Fourteenth Amdt.) Rules 2015, w.e.f. 1-10-2015. Earlier Form
No.15G was inserted by the IT (Fifth Amdt.)Rules, 1982, w.e.f. 21-6-1982 and later on
amended by the IT (Fifth Amdt.) Rules, 1989, w.r.e.f. 1-4-1988, IT (Fourteenth Amdt.)
Rules, 1990, w.e.f. 20-11-1990 and IT (Twelfth Amdt.) Rules, 2002, w.e.f. 21-6-2002
and substituted by the IT (Eighth Amdt.) Rules, 2003, w.e.f. 9-6-2003 and IT (Second
Amdt.)Rules, 2013, w.e.f. 19-2-2013.
 PART II

[To be filled by the person responsible for paying the income

referred to in column 16 of Part I]

1. Name of the person responsible for paying 2. Unique Identification No.11

3. PAN of the 4. Complete Address 5. TAN of the person responsible for

person paying
responsible for
paying
7. Telephone No. (with STD 8. Amount of income paid 12
6. Email Code) and Mobile No.
9. Date on which Declaration is 10. Date on which the income has been
received (DD/MM/YYYY) paid/credited (DD/MM/YYYY)

Place: ................................ ………………………………………..

Date: ............................................. Signature of the person responsible
for paying the income referred to in
column16ofPartI

*Delete whichever is not applicable.

1
As per provisions of section 206AA(2), the declaration under section 197A(1) or 197A(1A)
shall be invalid if the declarant fails to furnish his valid Permanent Account Number (PAN).
2
Declaration can be furnished by an individual under section 197 A (1) and a person (other
than a company or a firm) under section 197A(1A).
3
The financial year to which the income pertains.
4
Please mention the residential status as per the provisions of section 6 of the Income-
tax Act, 1961.
5
Please mention "Yes" if assessed to 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.
6
Please mention the amount of estimated total income of the previous year for which the
declaration is filed including the amount of income for which this declaration is made.
7
Incase any declaration(s) in Form No.15G is filed before filing this declaration during the
previous year, mention the total number of such Form No.15G filed alongwith the aggregate
amount of income for which said declaration(s) have been filed.
8
Mention the distinctive number of shares, account number of term deposit, recurring
deposit, National Savings Schemes, life insurance policy number, employee code, etc.
9
Indicate the capacity in which the declaration is furnished on behalf of a HUF, AOP,
etc.
10
Before signing the declaration/verification, the declarant should satisfy himself that the
information furnished in this form is true, 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-tax 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 fine;
(ii) in any other case, with rigorous imprisonment which shall not be less than three
months but which may extend to two years and with fine.
11
The person responsible for paying the income referred to in column16 of Part I shall allot
a unique identification number to all theFormNo.15G received by him during a quarter of
the financial year and report this reference number alongwith the particulars prescribed in
rule 31A(4)(vii) of the Income-tax Rules, 1962 in the TDS statement furnished for the same
quarter. Incase the person has also received FormNo.15H during the same quarter, please
allot separate series of serial number for FormNo.15G and FormNo.15H.
12
The person responsible for paying the income referred to in column 16 of Part I 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 amount which is not chargeable to tax. For deciding the
eligibility, he is required to verify income or the aggregate amount of incomes, as the case
may be, reported by the declarant in columns 16 and 18.