FORM NO. 15AA

FORM NO. 15AA

(See Rule 28AA)

Certificate under section 197(1) of the Income tax Act, 1961,

relating to deduction of tax

Certificate No. -

Income-tax Officer

To,

,

Date ------------- 19----

1. I hereby authorise you to pay without deduction of income tax, the salary/interest on securities/interest other than interest on securities/insurance commission. rent/ income in respect of units (strike out whichever is not applicable) payable by you on the under mentioned securities/ sums credited in the name of.

1. I hereby authorise you to pay the salary/interest on securities/interest other than interest on securities/insurance commission/rent/income in respect of units payable by you on the under mentioned securities/sums credited in the name of after deducting income tax at the rate of per cent and surcharge 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. This certificate shall remain in force upto unless it is canceled by me under intimation to you before that date.

Schedule I

Description of securities (1)

Number of securities (2)

Date of securities (3)

Amount of securities (4)

Schedule II

Sl.No.

Name and address of the person to whom the sums are given on interest

Amount of such sums?

The date on which such sums were given on interest

Period for which such sums were given on interest

Rate of interest

(1)

(2)

(3)

(4)

(5)

(6)

Schedule III

Sl. No.

Name and address of person responsible for paying insurance commission

Amount of insurance

(1)

(2)

(3)

Schedule IV

Sl. No.

Name and address of person responsible for paying salary

period of employment

Amount of salary

(1)

(2)

(3)

(4)

Schedule V

Sl. No.

Name and address of person responsible for paying rent

Amount of rent

(1)

(2)

(3)

Schedule VI

Sl. No.

Name and address of the mutual fund

Number of units

Class of units

Total face value

Distinctive

(1)

(2)

(3)

(4)

(5)

(6)

1. The certificate shall be cease to be operative in respect of any of the securities/sums mentioned herein which are transferred/debited by the present holder to any other person, from the date you receive notice of such transfer/debit.

(SEAL)

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(Assessing Officer)

Note : *Name and address of the person responsible for deducting tax.