ssutiot Bar Code ll FORMN ja0001 paw-[ 0. 15H [See section 197A(1C) and rule 29C] Declaration under section 197A(1.C) to bemade by an individual who is of the age of sixty years or mare claiming certain incames without deduction of tax. PAR’ TI T, Nane of Assesses (Declarant) Z PAW ofthe Asses” | 3 Dae of Biaht (@DIMM/YYYY) 4, Previous year V) (ior which declaration is being made) 5, FlavDeoriBiock No. & Name of Premises 7. RoaliStea/Lane | 8, ArealLocality 9. TownlGiy/Distict | 10. State TPA 12 Ema 13. Telephone No, (with STD Code) and Mobile No TA (@) Whelher ssccsed totem Ves. (b) léyes, latest assessment year for which assessed NoL_] TS. Estimated income for which this dedardioa 1s made Ts Eaimaled told income of the PY. ia which mncame mentioned in column 15 to be included’ T7, Details of Forma No 15H other than this form Sled for the previous year, any” ‘Total No.0! ‘orm NoISH fled ‘Aggregate ammount of icome for which Fora No 13H files 16, Details ofincome for which the dedadicnis Sled SL [WeniGedion number of No, | relevant investment/account, eto! ‘Nature oF inca Soin vader which taxis deductible “Amount ofincome HDFCBANKLID cust D: @FDRD NO SFDRDNO ‘@FDRDNO ‘@FDRD NO @FDRDNO @FDRD NO GFDRDNO sia.s02018 er Signature of the Declarant ‘Mandatory : To be fille by the Branch Cheelaist for Forin15 H For individual > 0 years) Fave checked and confimn the below fick (vor)| Customer is >= 60 years (if <60 years then ill forma 15 0) [PAN No. isundated in Bank Records aginst the Cust id of customer (Copy of PAN Card attaches (if not updated in te ayer [Customer nas agnedin sixplaces Gndicated yy) CB Fields:marked © aremandatary to be filled [Name of the Emp Emp. Code Emp. Sign DateDeclaration/Veritication® L. -clo hereby declare that I am resident in India within the meaning of section 6 of the Tncome-tax Act 1961. Talso hereby declare that to the best of my knowledge and belief wit is stated above is correct, complete and is truly stated and that the incornes referred to in this form are not includible in the total income of any other person under sections 60 to 64 of the Income-lax Act, 1961. I further declare that the tac en my estimated total income including *incomelincomes referred to in column 15 and aggregate amounl of income/incontes referred to in coluran 17 ccmputed in accordance withthe provisions of the Income-tax Act, 1961, for the previous year ending on relevant to the assessment year _vwill beni, er Place... he signature of the Declarant Dit: . PART IL [To be filled by the person responsible for paying the income referred to in column 15 of Part I] T, Name of the parson responsible fer paying 7 Unique Identification No. 3 PAN of the person responsible for [4 Gomplete Adires [5. TAN of the person responsible Tor paying paying, 6 Email 7, Telephone No. (with STD Code) and Mobile | 8. Amount of income paid" No. 3, Date on which Declaration is received | 10. Date on which the income has been paid/eredited @paaryyyy) (DMMYYYY) Place: ‘Signature of the person responsible for paying, Date: cassscsnenesees the income refered to in column 15 of Part 1 ‘Dae wcheris pie ‘hapa prvtens fe O2AA2) te larson dr ecion17A(C alta dwt fas iis wd Pmaseot Acne Maer (P41) XDelrdioncnbs ede eaten nid who ieee nef yea ree ay Sn dag the ons Fe "i fold yex wach rome pare eo Sere ese eaten "Yr" fare ota der te preconfe sree es ‘Beene snout of cmt incme te pein yo fr wich bBo ed inde te eae fucone wh is eho is mle ‘Teen ny dalasancg is ora No 15 Hel tbe Bln tas decarae ang rnc Je, meron a sub ch Poms Ne SH Sl ng nth he sgrgan sss fine ih ad Jerarace( hewn id ‘stone Sateuveousbe ofthe sri maar fem depot wring eon aon Sus Scenes inane policy mache, calor cae co ‘Reta aguante Selesin/srSc ain, de Sec dined ry mabe beim te in us ms one ad cag ine ea Any er {Dabeg te utenti eden sal elon prrtnion an secton 7 of be axons te: 0S seben canon be paseo Ginsu cha snug obeoved wears ay Srelroen ata goaapaet hl neler nx meni hy ead sete yen Gin. ae cae, itasigumasinrzncea wth het bles anther on tt vig exo en ye wih a "Racpatnseonale spying acne eee mln of bt ail alt some aeesken nater lhe arte SH convey ie ieg agua oth baal yen nd mp sree mie dng with psi psebe onde A) fe eras Riles 96 TOS mane ome! the fane gana lice tegen tar ce rerevel fore No 156 dangbe ak uate, plese alr spe sel me a fb No 1H ad Far No 156 ‘ite pron especie ying the ncn eee ncn fa Il oot ante Searot whee he on oftcume fice ate a ek WAL) art sepesde lect fou some coed er pb iy ae tied pa dun fe vi You avs cae tubal els ‘keene pet whch ean harp fo a Be log for defn) adn Chae VIL fey, oto oF der bd “cons om ae Proper id dels eghle for dese eighty, ots eae tcp cave che tpg non fincas werent eee he Adams cones 15031" 24198 eyo steam yo at ef anne yeas presente yearns be+611 000001 Bar Code TTT) BAI» “FORM NO. 156 [See section 1971}, 1S7A(LA) and rule 29C] Declaration under section 197 (1) and section 197A(LA) to hemade by an individual ora person (uot being. ‘company or firm) daiming certain incomes without deduction of tax, PARTI 1, Name of Asvessee (Declare) 7 PAN of the Assessee™ 3 Staue 4, Previous year(PY. 5. Residential Status orwhich declaration istbeing made) © Fla/Dour/slock No | 7, Name of Premisee 8, Road/Streatane | 9. ArealLocalty 10. Town/Giyfbistict | 11, State 12 Pi 13. Ema Wa, Telephone No. (with STD | 15 (@) Whelher assessed to tax under the Yes Wo Code) and Mobile No Income-taz Act, 19615 oo (b) ltyes, tes xcesement year for which assessed 16, Estimated income fer which his dedaraion is made 77. Estimated total income of the PY. in which {income mentioned in column 16 tobe inchuded® 6, Details of Form No. 15G other then this form Sled dunng the previous yea, any ‘Total No, of Form No. 150 Bled ‘Aggregate emnouat afiacome for which Form Ne 15G fled 1, Datalls oFincome for which the declarahon 1s Ole Si. | Identification rumber gf relevant | Nature ofincome | Section under which tax | Amount ofineome No, | investmert/ancount, te 42 deduetble DRC BARE LTD @custD, @FDRD NO (FDRD NO 1 (FDRDNO @FDAD NO. @FDRDNO ‘@FDRDNO @FDRDNO Signawre ofthe Dewan? ‘Mandatory: Tobe fill hy the Branch (Cheetaist for Form 1S G (Far indivilual less than 69 years) Thave checked and confi ihe below Tick (¥or™)| Custames is less than 60 vears (>= 601 yrs then Sil Fon 15H) PANNo. isupdated in Banke Record amine! the Cust of customer Copy of PAN Card attached (if not vpdated in the syste (Customer nas sgnedin sx places Gnticated iy) CB” [Fields marked © aretnandatory to be filed Name of the Emp Emp. Code, [Em Sign, DateDectaration/Verifieation'® "We. cccsaddo hereby deslare that to the best of *ray/our knowledge and belief what is ceo oy comple ad is tly sated. 1/ We declare et he fneomes refered to inthis Foon oe Ot Sa octane of any ler person onder sections 6D to Gtef the Income Act. 1961. U/W Panheg ood ee ee con ngfolr eared total income inching “income/neames refered to in clue 16 and seat smount of sincome/incomes refered ta in coluran 18 corputed in accardance Wit We provisions of the Haare gt, 1961, forthe previous year ening 6 wmv eleva othe assesamet YEA vill aca a Stap declare tat your *incomefnceres refered to in column 16 Yard the aaresite a of ae re ctamed to in clan 18 forthe previous year ending oh mn evan othe atsessnenh year net ill not exceed the maximum amount which is not chargeable to income-tax. Place: aft . Signature ofthe Declarant” Date: se PARTI [oe te by the person responsible for paying te income referred to incon 16 of Part I] 7, Name ofthe person responsibye for paying Unique Iaentification Na™ SPAN of the person | 4 Complete Address STAN atthe parson responsble or paying responsible for paying 6 Ena 7 Falephons Nov Win STD Code) and MobileNo. | & Amount oFincome paid Dae which” Deviation FFeceved | TO. Bate on which the income has Been paldleredited ODMMYYYY) DMT) Phace: oe ee : ‘Squat ofthe person responsible for paying Date: the income referred to in column 16 of Part "ee richer inet somite ‘Re ras ain so cart ers TA {erat sha eval the cat fats fo funih vad Pease Accu Aeris ve trae oy a8 natal ur SeETBelages owen ne neome pecans 2 TY sas oe pre pron steton Gale incre Act. 14 ‘Reg erty fags ot ovo FMEA Act BEN secs yar Ox fs assessment year pete ear CHE et ea neat to ev yar wk te saan Res ong he smc fee whch ST “Ais rearzangye ren 180 tea eo rg denon ge Wann Yen etn eta Mea of AFD HOA wn ott ncone far vieh sad Gerson) pave Den ed EE SREB smo atbnk number Fo Sepse, fcurng depos. Maton! Sos Sree. son 7A(y a ues ater bana company eran) under secbon ¥87AA) ier feneurres pokey nunbar empayer co. ee canary nwneh he deraban i fumshed on bei UT AOR, “eae a eet ie Geran as ay eS Pa Se ae ae saamert mine colraon eral bie 1 usec ne eatin tninedin i frm te, cect afd comple a rxptels ANY oa a asm tat ne 96% ara on coraebon De risa He ee ees ees warms moioen wero ice in sete EE ont we may etn 2 Uanyeaearawa ne sete yous preomereyne sa ete van es noni keh ey Soe HO Tae comi Se ee cere coun Weta aaa aes OTST oe ura esa yim ang ten eri FOES re uncer argh eon eee AGN ats sare ‘teameret ies teegme er nse open sarebe rom Ne 4 SI a iar pos bteepace ses oer ner Fem HEE ram rpayngne nce eri cain ol atl nao cre AO AUN G2 ot tae pa referee 20 i pera spo asl spe aocoonse?mrtta save of ne amu | ‘coca orgs eng te re EATEN eae ese cent tenatu amauin sO SS tenaneata vorspcone oe ee incomes a: Me eve Moy oe, epomeS ye eC cS