INCOME-TAX RULES, 1962

lFORM 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

PART I

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1. Name of Assessee (Declarant) 2. PAN of the Assessee

2 3 4
3. Status 4. Previous year (P.Y.) 5. Residential Status
(for which declaration is being
made)
Individual 2022-2023 Resident
6. Flat/Door/Block 7. Name of 8. Road/ Street/ 9. Area/Locality
No. Premises Lane

10. Town/ City/ 11. State 12. PIN 13. Email

District

14. Telephone No. (with 15 (a) Whether assessed to tax under the Yes No
Income-tax Act, 19615:
STD Code) and Mobile
No. (b) If yes, latest assessment year for which assessed

16. Estimated income for which this 17. Estimated total income of the P.Y. in which
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declaration is made income mentioned in column 16 to be included

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18. Details of Form No. 15G other than this form filed during the previous year, if any

Total No. of Form No. 15G Aggregate amount of income for which Form No.15G filed
filed

19. Details of income for which the declaration is filed

Sl. Identification number of Nature of Section Amount of income
No. relevant investment/ income under which
account, etc. S tax is
deductible
Dividend 194

...............................................................
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Signature of the Declarant
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Declaration/Verification
* 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 31st March, 2023
relevant to the assessment year AY2023-2024 …… … will be nil. *I/We also declare that *my/our
*income/incomes referred to in column 16 *and the aggregate amount of *income/incomes
referred to in column 18 for the previous year ending on relevant to the assessment year
A.Y. 2023-2024 will not exceed the maximum amount which is not chargeable to income tax.

Place: ........................................ ...............................................................

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Date: ........................................ Signature of the Declarant

1. Substituted by IT (Fourteenth Arndt.) Rules 2015, w.e.f. 1-10-2015. Earlier Forrn No. 15G
was inserted by the IT (Fifth Arndt.) Rules, 1982, w.e.f. 21-6-1982 and later on arnended by
the IT (Fifth Arndt.) Rules, 1989, w.r.e.f. 1-4-1988, IT (Fourteenth Arndt.) Rules, 1990,
w.e.f. 20-11-1990 and IT (Twelfth Arndt.) Rules, 2002, w.e.f. 21-6-2002 and substituted by
the IT (Eighth Arndt.) Rules, 2003, w.e.f. 9-6-2003 and IT (Second Arndt.) 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

Tata Consultancy Services Limited
3. PAN of the person 4. Complete Address 5. TAN of the person responsible for paying
responsible for paying
AAACR4849R Nariman Point, Mumbai MUMT24925F

6. Email 7. Telephone No. (with STD Code) 8. Amount of income paid12

and Mobile No.

9. Date on which Declaration is received 10. Date on which the income has been paid/credited
(DD/MM/YYYY) (DD/MM/YYYY)

Place: .......................................... .................................................................................................

Date: .......................................... Signature of the person responsible for paying the
income referred to in column 16 of Part I

*Delete
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or write N.A, whichever is not applicable.
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 197A(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
In case 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 along with 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.

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Indicate the capacity in which the declaration is furnished on behalf of a HUF, AOP, etc.
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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.
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The person responsible for paying the income referred to in column 16 of Part 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, please
allot separate series of serial number for Form No.15G and Form No.15H.
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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.