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Form & Application for remittance under
section 195
of the Income-tax Act
1. | Name and Address of the Applicant and principal place of
business | : |
2. | Name and Address of the Assessing Officer having
jurisdiction over theremitters | : |
3. | Applicants PAN Number | : |
4. | Name and address of the beneficiary of the remittance
and the country towhich remittance is made | : |
5. | Amount and nature of remittance | : |
6. | Rate of deduction of tax at source | : |
7. | Reference to provision of Act/DTAA under which the rate
has been determined | : |
8. | Certificate | |
(i)I/We propose to
make the above remittance as per deduction of tax at source indicated above. We
have obtained a certificate from M/s. ..... who is an accountant as defined in
section 288 of the Income-tax Act, certifying the amount, nature and
correctness of deduction of tax at source.
(ii)In case the
income-tax authority at any time finds that tax actually deductible on the
amount of remittance has either not been paid or not paid in full, I/we
undertake to pay the said amount of tax along with interest due.
(iii)I/We shall also
be subjected to the provisions of penalty for the said default as per the
provisions of Income-tax Act.
(iv)I/We undertake to
submit the requisite documents, etc., for enabling the income-tax authorities
to determine the nature and amount of income of the beneficiary of the above
remittance as well as documents required for determining our liabilities under
the Income-tax Act as a person responsible for deduction of tax at source.
(v)The information
given above is true to the best of my/our knowledge and belief and no relevant
information has been concealed.
..............................................
Name and Signature
[To be signed by a person responsible for signing the
return of income (as to provisions of section 139(A) of the Income-tax Act) of
the person making the remittance].
Annexure B
Certificate
I/We have examined the agreement (wherever applicable)
between M/s. ............................
..................................................................... and M/s.
........................................................ requiring the
remittersbeneficiary
above remittance as well as the relevant documents
and books of account required for ascertaining the nature of remittance and for
determining the rate of deduction of tax at source as per provisions of section
195. We hereby certify the following :
1. | Name and address of the beneficiary of the remittance
and the name of the foreign country to which remittance is being made. | : | | |
2. | Amount of remittance is foreign currency indicating the proposed
date/month and bank through which remittance is being made. | : | | |
3. | Details of tax deducted at source, rate at which tax has
been deducted and date of deduction. | : | Foreign Currency | Indian Currency |
| Amount to be remitted | | ..... | ..... |
| Tax deducted at source | | ..... | ...... |
| Actual Amount remitted | | ..... | ..... |
| Rate at which deducted | | ..... | ..... |
| Date of Deduction | | ...... | ..... |
4. | In case the remittance as indicated in (2) above is net
of taxes, whether tax payable has been grossed up? If so, computation thereof
may be indicated. | : | | |
5. | If the remittance is for royalties, fee for technical services,
interest, dividend, etc., the clause of the relevant DTAA under which the
remittance is covered along with reasons and the rate at which tax is
required to be deducted in terms of such clause of the applicable DTAA. | : | | |
6. | In case that tax has been deducted at a rate lower than
the rate prescribed under the applicable DTAA, the reasons thereof. | : | | |
7. | In case remittance is for supply of articles or things (e.g.,
plant, machinery, equipment, etc.) or computer software, please indicate : | : | | |
| i. Whether there is any permanent establishment
in India through which the beneficiary of the remittance is directly or
indirectly carrying on such activity of supply of articles or things? | | | |
| ii. Whether such remittance is attributable to or
connected with such permanent establishment? | | | |
| iii .If so, the amount of income comprised in
such remittance which is liable to tax. | | | |
| iv. If not, the reasons in brief therefor. | | | |
8. | In case remittance is on account of business income | | | |
| please indicate : | : | | |
| i. Whether such income is liable to tax in India? | | | |
| ii. If so, the basis for arriving at the rate of
deduction of tax. | | | |
| iii. If not, the reasons thereof. | | | |
9. | In case tax is not deducted at source for any other
reason,details thereof. | : | | |
(Attach separate sheet duly
authenticated wherever necessary)
.........................................................................................
Name, Address and registration
numbers
(To be signed and verified by an Accountant as
defined in section 288 of the Income-tax Act).
[ The aforesaid form is annexure to the Circular : No.
10/2002, dated 9-10-2002.