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[FORM No. 15AA :

Certificate under section 197(1)
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[*** of t!e "nco#e$ta% Act& 1961& re'atin( to deduction of
ta%
[See rule 28AA]
Certificate No. _______________ Income-tax Officer,
*To
________________ __________________
_______________ _________________
Date ___________
1. I hereby authorise you to pay without euction of income-tax, the
!
"sa#ary$% interest on
securities$ interest other than interest on securities$insurance commission
&'
"commission (not
bein) insurance commission* or bro+era)e%
,
"$ rent%
-
"$ income in respect of units% (stri+e out
whiche.er is not app#icab#e* payab#e by you on the unermentione securities$sums creite in
the name of ____________.
&. I hereby authorise you to pay the
!
"sa#ary$% interest on securities$interest other than interest on
securities$ insurance commission
,
"$ rent%
-
"$ income in respect of units% payab#e by you on the
unermentione securities$ sums creite in the name of __________ after euctin) income-tax
at the rate of ________________ per cent an surchar)e at the rate of __________________ per
cent of the amount of the interest on securities$ interest other than interest on securities$
insurance commission
,
"$ rent%
-
"$ income in respect of units%.
1/
"&0. I hereby authorise you to pay the unermentione sum bein) in the nature of
compensation or the enhance compensation or the consieration or the enhance consieration
on account of compu#sory ac1uisition of the capita# asset without euction of income-tax$ after
euctin) income-tax at the rate of _______________ per cent an surchar)e at the rate of
________ per cent of such sum (stri+e out whiche.er is not app#icab#e*%.
2. This certificate sha## remain in force up to _________________ un#ess it is cance##e by me
uner intimation to you before that ate.
)C*+,-.+ "
,escri/tion of
securities
Nu#0er of securities ,ate of securities A#ount of securities
(1) (1) (2) (3)
)C*+,-.+ ""
)'.
No.
Na#e and address
of t!e /erson to
4!o# t!e su#s are
(i5en on interest
A#ount of
suc! su#s
6!e date on
4!ic! suc!
su#s 4ere
(i5en on
interest
7eriod for
4!ic! suc!
su#s 4ere
(i5en on
interest
Rate of interest
(1) (1) (2) (3) (5) (6)
)C*+,-.+ """
)'. No. Na#e and address of /erson res/onsi0'e for
/a8in( insurance co##ission
A#ount of insurance
co##ission
(1) (1) (2)
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[)C*+,-.+ "9
)'.No. Na#e and address of
/erson res/onsi0'e for
/a8in( sa'ar8
7eriod of e#/'o8#ent A#ount of sa'ar8
(1) (1) (2) (3)
:
[)C*+,-.+ 9
)'. No. Na#e and address of /ersons res/onsi0'e
for /a8in( rent
A#ount of rent
(1) (1) (2)
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[)C*+,-.+ 9"
)'. No. Na#e and
address of
t!e #utua'
fund
Nu#0
er of
units
C'ass of units and
face 5a'ue of eac!
unit
6ota' face
5a'ue of
units
,istincti5e
Nos. of
units
(1) (1) (2) (3) (5) (6)
1;
[)C*+,-.+ 9""
)'. No. Na#e and address of t!e /erson res/onsi0'e for
/a8in( co#/ensation or t!e en!anced
co#/ensation or t!e consideration or t!e
en!anced consideration on account of co#/u'sor8
ac<uisition of t!e ca/ita' asset
A#ount of
co#/ensation or t!e
en!anced co#/ensation
or t!e consideration or
t!e en!anced
consideration
(1) (1) (2)
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[)C*+,-.+ 9"""
)'. No. Na#e and address of t!e /erson res/onsi0'e for
/a8in( co##ission (not 0ein( insurance
co##ission referred to in section 193,) or
0ro=era(e
A#ount of co##ission (not
0ein( insurance co##ission
referred to in section 193,) or
0ro=era(e
(1) (1) (2)
3. The certificate sha## cease to be operati.e in respect of any of the securities$ sums mentione
herein which are transferre$ ebite by the present ho#er to any other person, from the ate you
recei.e notice of such transfer$ ebit.
(4506* ________________
0ssessin) Officer
Note : *Name an aress of the person responsib#e for euctin) tax.%