Declaration for issuance of Form 16C, for the TDS deducted

against the rent payment u/s 194 IB of Income Tax Act 1961
(This is applicable only in case monthly rent exceed Rs.50000)

TO WHOMOSEVER IT MAY CONCENRN

This is to confirm that I, ……………………………….……………………. (name), S/o.

………………………………………………,
E-code ………………………., has taken a house on rent as per following details.

Name of Landlord:

PAN of Landlord:

Address of the

property: Monthly

Rent:

And certify that I will furnish the details for the TDS deducted on the rent paid by me in Form
26QC as prescribed u/s 194 IB of the Income Tax Act. Further I will also issue Form 16C to my
landlord under the mentioned section of the act.

In case of any default the tax along with the interest, if any, may be deducted from my salary.

Signature
Name of the
employee: E-code:
PAN: