Income-Tax FORM NO. 15CA Ack. No.

Department (See rule 37BB)

Information to be furnished for payments to a non-
resident not being a company, or to a foreign company
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)
Name of remitter
RE PAN of the remitter (if available)
MI TAN of the remitter (if available)
TT Complete address, email and phone number of the
remitter
ER Status of remitter1

Residential status of remitter2

RE Name of recipient of remittance
MI PAN of the recipient of remittance, if available3
TT Complete address, email4 and phone number5 of the
recipient of remittance
EE Country to which remittance is made
Amount payable before TDS (In Indian Currency)
RE Aggregate amount of remittances made during
the financial year including this proposed
MI remittance
Name of bank
TT
Name of the branch of the bank
AN
Proposed date of remittance
CE
Nature of remittance
Please furnish the relevant purpose code as per RBI
Amount of TDS
Rate of TDS
Date of deduction
 VERIFICATION
I/We*, (full name in block letters), son/daughter of
in the capacity of (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. I/We* 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 as a person responsible for deduction of tax at source.
…………………………………….
Place: …………………… Signature of the person
responsible for paying to
non-resident

……………………………………
Date: ……………… Name and Designation of the person
responsible for paying to non-resident
* Delete whichever is not applicable.
1
Write 1 if company, write 2 if firm, write 3 if individual and write 4 if others.
2
In case of company, write 1 if domestic company, write 2 if foreign company, in case of person
other than company, write 3 if resident, write 4 if non-resident
3
In case of non-availability of PAN, provisions of section206AA shall be applicable
4. If

available 5.If
available
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.)
Name of remitter
RE PAN of the remitter
MI TAN of the remitter1
TT Complete address, email and phone number of the remitter
ER Status of remitter2
Residential status of remitter3
RE Name of recipient of remittance
MIT PAN of the recipient of remittance, if available4
TEE Complete address, email5 and phone number6 of the recipient
of remittance
 A.O. Section under which order/certificate

OR Name and designation of the Assessing

DE order/certificate
R Date of order/certificate
Order/ certificate number
Country to which remittance is made
Amount payable

VERIFICATION
I/We*, (full name in block letters), son/daughter of
in the capacity of (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. I/We* certify that a certificate/order under section
195(2)/195(3)/197 of the Income-tax Act, 1961 has been obtained, particulars of which are given
in this Form. I/We* 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
as a person responsible for deduction of tax at source.
………………………………………………………….
Place: ……………… Signature of the person responsible
for paying to non-
resident

....................…………………………………………
…
Date: ……………… Name and Designation of the person
responsible for paying to non-resident
* Delete whichever is not applicable.
1In case TAN is applied for, please furnish acknowledgement number of the application.
2 Write 1 if company, write 2 if firm, write 3 if individual and write 4 if others.
3
In case of company, write 1 if domestic company, write 2 if foreign company, in case of person
other than company, write 3 if resident, write 4 if non-resident.
4
In case of non-availability of PAN, provisions of section206AA shall be
applicable. 5 If available
6 If available.
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)
Section A GENERAL INFORMATION
Name of the remitter
RE PAN of remitter Area Code Range Code
MI AO Type AO No
TT Principal Place of Business TAN of remitter1
ER Complete address, email and phone number of the
remitter
Status2 Residential status of remitter3
Name of recipient of remittance
RE PAN of recipient of remittance4
MI Status5
TT Address Country to which remittance is made:
EE
Principal place of Email address (ISD code)- ( )
business Phone Number

AC (a) Name of the Accountant6 signing the

certificate
CO (b) Name of the proprietorship/firm of the
accountant
UN (c) Address
TA (d) Registration No. of the accountant
NT (e) Date of certificate (DD/MM/YYYY)
Certificate No.7
A.O. (a) Whether any order/ certificate u/s 195(2)/ (Tick) … Yes … No
195(3)/ 197 of Income-tax Act has been . .
 obtained from the Assessing Officer.
OR (b) Section under which order/certificate has
DE been obtained
R (c) Name and designation of the Assessing
Officer who issued the order/certificate
(d) Date of order/certificate
(e) Order/ certificate number

Section B PARTICULARS OF REMITTANCE AND TDS ( as per certificate of the accountant)

1. Country to which remittance is made Country: Currency:
2. Amount payable In foreign In Indian Rs.
currency:
RE 3. Name of the Bank Branch of the Bank
MI
TT 4. BSR Code of the bank branch (7 digit)
AN 5. Proposed date of remittance DD/MM/YYYY)
CE 6. Nature of remittance as per agreement/ document
7. Relevant purpose code as per RBI
8. In case the remittance is net of taxes, whether tax (Tick) Yes No
payable has been grossed up?
9. Taxability under the provisions of the Income-tax
Act (without considering DTAA)
I.T. (a) the relevant section of the Act under which the
remittance is covered
AC (b) the amount of income chargeable to tax
T (c) the tax liability
(d) basis of determining taxable income and tax
liability
10. If any relief is claimed under DTAA-(i) whether
tax residency certificate is obtained from the (Tick) Yes No
recipient of remittance
DT (ii) please specify relevant DTAA
AA (iii) please specify relevant article of DTAA Nature of payment as per 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
technical services, interest, dividend, etc., (not (Tick) Yes No
connected with permanent establishment) please
indicate:-
(a)Article of DTAA
(b) Rate of TDS required to be deducted in terms As per DTAA (%)
of such article of the applicable DTAA
B. In case the remittance is on account of
business income, please indicate:- (Tick) Yes No
 (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 (Tick) Yes No
capital 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 Yes No
sub-items A, B and C
(a) Please specify nature of remittance
(b) Whether taxable in India as per DTAA
(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
specifying relevant article of DTAA
11. Amount of tax deducted at source In foreign currency
In Indian Rs.
TD 12. Rate of TDS As per Income-tax Act
S (%)
or As per DTAA (%)
13. Actual amount of remittance after TDS Date of In foreign currency
14. deduction of tax at source, if any (DD/MM/YYYY)

VERIFICATION
1. I/We*, (full name in block letters), son/daughter of in the capacity of
(designation) solemnly declare that the information given above is true to the best of my/our*
knowledge and belief and no relevant information has been concealed. I/We* 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. 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/We* undertake to pay the
amount of tax not deducted or not paid, as the case may be, along with interest due. I/We* shall also be subject to
the provisions of penalty for the said default as per the provisions of the Income-tax Act, 1961. I/We* 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/our
liability under the Income-tax Act, 1961 as a person responsible for deduction of tax at source.

………………………………….
Place: ……………… Signature of the person responsible for paying to non-resident
 …………………………………
Date: ………… Name and Designation of the person responsible for paying to non-resident
* Delete whichever is not applicable.
1In case TAN is applied for, please furnish acknowledgement number of the application.
2 Write 1 if company, write 2 if firm, write 3 if individual and write 4 if others.
3 In case of company, write 1 if domestic company, write 2 if foreign company, in case of person other than
company, write 3 if resident, write 4 if non-resident.
4In case of non-availability of PAN, provisions of section 206AA shall be applicable.
5 Write 1 if company, write 2 if firm, write 3 if individual and write 4 if others.
6Accountant shall have the meaning as defined in Explanation below sub-section (2) of section 288 of the Income-
tax Act, 1961.
7Please fill the serial number as mentioned in the certificate of the accountant.
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)]
Name of the remitter
RE PAN of the remitter, if available
MI TAN of the remitter, if available
TT Complete address, email and phone number of the remitter
ER Status of remitter1
Residential status of the remitter2
RE Name of recipient of remittance
MI PAN of the recipient of remittance, if available
TT Complete address, email3 and phone number4 of the recipient of
remittance
EE Country to which remittance is made Country: Currency:
Country of which the recipient of remittance is resident, if available
RE Amount payable In foreign currency: In Indian Rs.
MI Name of the bank Name of the branch of the bank
TT BSR code of the bank branch (7 digit)
AN Proposed date of remittance DD/MM/YYYY)
CE Nature of remittance
Please furnish the relevant purpose code as per RBI

2. I certify that I have reason to believe that the remittance as above is not chargeable under the provision
of Income-tax Act 1961 and is not liable for deduction of tax at source.
 VERIFICATION
I/We*, (full name in block letters), son/daughter of in the capacity of
(designation) solemnly declare that the information given above is true to the best of my/our*
knowledge and belief and no relevant information has been concealed. In a 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/We* undertake to pay the amount of tax not deducted or not paid, as the case may be, along with
interest due. I/We* shall also be subject to the provisions of penalty for the said default as per the provisions of the
Income-tax Act, 1961. I/We* 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/our* liability under the Income-tax Act as a person responsible for
deduction of tax at source.
…………………………………………….
Place: ……………… Signature of the person responsible for paying to non-resident

....................………………………………
Date: ……………… Name and Designation of the person
responsible for paying to non-resident
* Delete whichever is not applicable.
1
Write 1 if company, write 2 if firm, write 3 if individual and write 4 if others.
2
In case of company, write 1 if domestic company, write 2 if foreign company, in case of person other than
company, write 3 if resident, write 4 if non-resident.
3
If available.
4
If available.

For Office Use only For Office Use Only Receipt No. ………………
Date ………………
Seal and Signature of receiving official