Form No. 60

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ANNEXURE: II

“FORM NO. 60 [See second proviso to rule 114B]


Form for declaration to be filed by an individual or a person (not being a company or firm) who does not have a permanent account number and who
enters into any transaction specified in rule 114B
1 First Name 2
Date of Birth / Incorporation of
declarant
Middle Name
D D M M Y Y Y Y

Surname

3 Father’s Name (i) First Name

Middle Name

Surname

4 Flat/Room No. 5 Floor No.

6 Name of premises 7 Block Name/No.

8 Road/Street/Lane 9 Area/Locality

10 Town/City 11 District 12 State

13 Pincode 14 Telephone Number (with 15 Mobile Number


STD code)
16 Amount of transaction (Rs.) 18 In case of transaction in
Joint names, number of
17 Date of transaction D D M M Y Y Y Y Persons involved in the
transaction
19 Mode of transaction

Cash Cheque Card Draft/Banker’s Online transfer,Cheque Other


20 Aadhaar Number issued by
UIDAI (if available)
21 If applied for PAN and it is not yet generated
Enter date of application and acknowledgement D D M M Y Y Y Y
number
22 If PAN not appliced, fill estimated total income (including income of spouse, minor child etc. as per Section 64 of Income-tax Act,
1961) for the financial year in which the above transaction is held

a Agriculatural income (Rs.)


b Other than agricultural
income (Rs.)
23 Details of document being produced in support of Document Document identification Name and address of the
identity in Col 1 (Refer instruction overleaf) Code Number authority issuing the document

24 Details of document being produced in Document Document identification Name and address of the
support of address in Col 1 (Refer Code Number authority issuing the document
instruction overleaf)
Verification
I, _______________________________________________ do hereby declare that what is stated above is true to the best of my knowledge and
belief. I further declare that I do not have a Permanent Account Number and my/ our estimated total income (including income of spouse, minor child
etc. as per section 64 of Income-tax Act, 1961) computed in accordance with the provisions of Income-tax Act, 1961 for the financial year
in which the above transaction is held will be less than maximum amount not chargeable to tax.
Verified today, the ______________ day of ______________ 20_____
Place: ____________ (Signature of declarant)

Note:
1. Before signing the declaration, 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.
2. The person accepting the declaration shall not accept the declaration where the amount of income of the nature referred to in term 22B exceeds the
maximum amount which is not chargeable to tax, unless PAN is applied for and column 21 is duly filled.

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