FORM NO.

10DB
[See rule 20AB]
Form for evidence of payment of securities transaction tax on transactions entered in a recognised stock exchange

Name of the assessee : RAMESH KUMARI

Name of the stock broker : ICICI Securities Limited
Address of the assessee :
FLAT NO 402 GHS 21 FLR DIVYA APARTMENT SECTOR 27 Address of the stock broker : Shree Sawan Knowledge Park,
Gr. Floor, Plot No. D-507, TTC Industrial Area, MIDC, Turbhe
Navi Mumbai-400 705,
Maharastra
PANCHKULA - 134116 India
HARYANA
INDIA
Permanent Account Number (PAN) of the assessee : AEMPK1119A Stock broker code : 07730

Name of the Stock Exchange in which transaction entered into : THE NATIONAL STOCK EXCHANGE

Financial year : 2019 - 2020

Details of value of securities transactions and securities transaction tax collected from the assesses:

Client code Code* of Value of Total securities Value of transactions Securities transaction tax
number transaction transactions transaction tax (included in value given in collected on value of
entered into during collected from the column 3) entered into in transactions given in
the financial year assessee during the the course of business by column 5
financial year the assessee

1 2 3 4 5 6
8505149971 01 41,370.00 0.00 41,370.00 0.00

8505149971 02 0.00 0.00 0.00 0.00

8505149971 03 0.00 0.00 0.00 0.00

Total 41,370.00 0.00 41,370.00 0.00

Dear Customer, the STT amount mentioned above does not include the STT amount refunded to you, from time to time, towards the cross-exchange intraday
trades done by you in equity segment during the year.
Verification
I RAMESH KUMARI son/daughter of __________________ solemnly declare that to the best of my knowledge and belief the information given in this Form is
correct and complete and that the total amount of securities transaction tax shown therein is truly stated and is in accordance with the provisions of Chapter
VII of the Finance (No. 2) Act, 2004 and Securities Transaction Tax Rules, 2004.

Date 05-Jun-2020
Place Mumbai
(Name and Signature of the assessee)

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 *CODES IN RESPECT OF TAXABLE SECURITIES TRANSACTION

S.No. Nature of Transaction Code

1. Purchase of an equity share in a company or a unit of an equity oriented fund, where? 01

(a) the transaction of such purchase is entered into in a recognised stock exchange; and

(b) the contract for the purchase of such share or unit is settled by the actual delivery

2. Sale of an equity share in a company or a unit of an equity oriented fund, where? 02

(a) the transaction of such sale is entered into in a recognised stock exchange; and

(b) the contract for the sale of such share or unit is settled by the actual delivery or transfer of
such share or unit.

3. Sale of an equity share in a company or a unit of an equity oriented fund, where? 03

(a) the transaction of such sale is entered into in a recognised stock exchange; and

(b) the contract for the sale of such share or unit is settled otherwise than by the actual delivery
or transfer of such share or unit.

4. Sale of a derivative being "option in securities", where the transaction of such sale is entered 04
into in a recognised stock exchange.

5. Sale of a derivative being "futures", where the transaction of such sale is entered into in a 05
recognised stock exchange.

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