Application for a certificate under section 194J(2)

FORM NO. 13E

[See rule 28(5)]

Application for a certificate under section 194J(2) of the Income-tax Act, 1961, relating to deduction of income-tax from payments of fees for professional or technical services?

To,

The Assessing Officer,

Sir,

I,,

[name]?

of do hereby declare that?

[address]?

my total income (including income comprised in payments of the nature referred to in section 194J of the income-tax Act, 1961) computed in accordance with the provisions of that Act for the previous year relevant to the assessment year 19? ? ?19 ????*was less than the minimum liable to income-tax/amounted to Rs............... and I have no reason to expect that my total income (computed as aforesaid) for three assessment years next following will increase substantially.?

2. I, therefor, request that a certificate may be issued to the person(s) responsible for paying any sum by way of fees for professional/technical services. Particulars of which are given in the Schedule hereto, authorising him/them not to deduct income-tax/to deduct income-tax at the rate of .............................per cent at the? time of credit of such income to my account or, as the case may be, payment thereof to me.?

3. I hereby declare that what is stated in this application is correct.

Date

Signature?

Address

Permanent Account Number ?

SCHEDULE?

Sr. No.

Name and address of person(s) responsible for paying fees for *professional/technical services

Amount of *professional/technical services

Date .............................. ............................................................

Signature

*Score out whichever is not applicable.