(To be printed on letter head and signed with seal)

Date:

To,
Purchase / Accounts Department,
International Combustion (India) Limited
(Unit’s address to be mentioned e.g. Baidyabati/Nagpur/Aurangabad/Ajmer/Head Office )

Subject: Declaration with respect to my / our filing of income tax returns for the purpose of Section
206AB of the Income-tax Act, 1961

With reference to your mail communication dated --------, and to comply with the newly inserted section 206AB
of the Income-tax Act, 1961 and as per Section 139AA read with Rule 114AAA, we would like to submit the
below mentioned information:

PAN
TAN
Whether return of income has been filed for two Yes / No / N.A (if yes please provide the
consecutive preceding previous year? acknowledgement no & date in below column)
P Y 2020-21 (A Y 2021-22) Provide reasons for selecting N.A)
P Y 2021-22 (A Y 2022-23)
(Attach Screen shots from reporting portal)

Whether TDS / TCS in each year is more than Rs Yes / No / N.A (if yes please provide the amount in
50,000/-? below column) (Provide reasons for selecting N.A)
P Y 2020-21 (A Y 2021-22)
P Y 2021-22 (A Y 2022-23)

Estimated Gross Turnover / Gross Receipts from

Business during PY 22-23.(INR in lakhs)
In case of individual buyer, whether PAN and Yes / No / Not applicable (if yes please provide the
Aadhaar is linked? Not applicable in case of other screen shot of the same)
than individual buyer.

I / we hereby certify that the declaration made above is true and correct.

In the event that the above declaration is found to be false or incorrect, due to which International Combustion
(India) Limited is held liable for any penal action under the Act, then, I / we undertake to indemnify
International Combustion (India) Limited towards any loss / damage incurred in this regard.

Yours sincerely,
<<Name of Vendor>>

<<Designation>>
<<Sign and Stamp>>
<<Place>>