456110000001 Bia Codes TUINVMININL PAN: FORM NO.15G [See rule 29¢] Declaration under sibsctions (!) an A) of ection I9TA ofthe Incomes Act, 1961, te mad hy am inves fru peson (aot being a eompany ar 4 Gem) el g sala recite wild donor ix oxida ae cnt daharey deca bye. andtbe cvidends hein ne not nuda he ttaliacome of aay oer prsonunle scious 010640 te eames ALL. 961 ha the sects ox stn, pata of which are given in Scheuer Schade Ilo SchlsleV tla, sun Yayow same and Retell beans > “aun parca my accuse dere Navona Sev Schome td ihe mount fw ihdawalereasper he Seed V blow; see Welw *thounounteteredincase(aofsubsoetion(2 oFsection ICCA, mentioned in ShedaleV below, computed in aevordinee Win he plots of e Incame- x Ad, 1951 he previous youre 9... oof eabesmeHt 4. shar *myeur come fom *videndineres cn ceuisinwrest ote tha "mers on secure sitlanoust feel 1 in clause (a) ofsubseton (2) of 2 (CURRENT FINANCIALYEAR) clvant the sssesneat eur 20... ~ 20. [NEXT FINANCIAL YEAR) vil it oxced he manu S. that we have no bee assessed income at any ime in th pest ut | fll within the justin of te Chie Commissioner of Commissioner of (CuclesWardDistctap he permanent scout umber ated 6 6 Thatl*novan stress ia ad vith de meaning ofan crooner Bye seing Oe ne 5 7. Patiala of the tars ofthe cnmpanyaccartievaunanccoul wader the National SarngSchcn andthe ancuat of withdamal eer tin paagrap | cove, snvespestf which the declan being nade tees nder SCHEDULED Noe Clas af iar and fice "Tol fie vaca shares Disiicive mba? Daisy an whee ‘Shares "also sac share, iheshares sues weteacaued irucdscanar séubouiew Desipion ot sates ‘Naber of seas Diidt oF eur “Ranaut oF ere ‘Diesyon wENS seumter ere sequt bye doit Mandatory : To be filed by the Brancl, (Cheektist for Form 15 G (For individual less th 65 years) Thave checked and contiam the below [Customer is lss than 6S years (f= 68 yrs then fill Form 19H) | PAN No. is updated in Bank Records against the Cust id of customer | |Copy of PAN Card antached (not updated in the system) ( Branch [customer has signed in four places (indicated by) > a eden oer aye | ihe yf ey Name ofthe Emp Ep. Code | Fp. Sig DareSCHEDULE ML Wine ind aio ie Tmowirafsach suns | Dale which wns | PerdTor vheksach | Rave ofieet pence wha sas wategveenaiees | Mosice ghar DECHANKEED [ENO [eFDNO /SFDNO. ern Wamberah Clas stunted Tee Tame ape oe Sales femh woe cia 65 yrs then fill Form ISI), Proprietorship, Society. Associations ‘of Porsoas, Trust, HUF ete "TDS waiver will not be marked if PAN detals are not updated on the Bank's records ‘TDS waiver will be marked fFom the dae of submission ofthis form “TDS which has already been deducted will at be refunded back and whick can be sought from tncome Tax department ‘A{resh Form 134 needs to be submited in each new Financial Year within the star of the Finagcial Year. Foran ISG nceds to be submited in Triplicate Form 15G needs wo be submited for every fixed Deposits booked with ban ‘The Bank shull not be lable for any consequences oF loss arsing due to delay or aon or wrong submission of Form 15G We fully understand thot wrong quoting of PAN may result i petal consequences under section 2728 of Inconte Tax act 1961 and the bank is not responsible for any consequences arising due wrung quoting of PAN45G410000001 Haida DIMA PAN: FORM NO.15G [See rule 29¢] Declaration under sibscticns (1) and (1A) of ction 197A ofthe Lncome ti Act, 161, be ade bya individual fru person (aot bing « npn or 4 Gem) elaming certain ecipa wahot dedaton of tx souidaugee'iteot i dohatey sane bye andi cvidnds hereto se notable ahetoaliacome ofan ollerprson nk sections 60.0 64ofthelacmo-axAct, 961 ht he sects o suns, atic of which re givin Schell or Scot lor Sehedule LV below, tan “your mune and beefy bang te ante Welw ‘de unounteteredtinchuse|a)ofsub-oction(2Jofsetion SCC, mentinedinSchaleV tw, computed in avordunce Win ihe plotsons of Be Insane AC, 9S fr ePEVNS Yeu ER Wan sen EVANS EE 4. shar *myuriecome fom *avidendimerst an seuss ote tha "mores 8 cceitsuitamcunt tefered tia ease (4) ofsubsceten (2) of 2a (CURRENT FINANCIAL YEAR) lvat (the essen’ yar 2... ~ 20. [NEXT FINANCIAL YEAR wilt exec themsnute 5. tha “we have not been ssesied 1 income ax a any ine in the past bu 1 fll within the juisdicion ofthe Chief Commissioner of Conmissoner of (Cc WaDistctapt he permanent account aumberaloted10M 8 acne 6. Thatt*en/an sotrsicos ie nda vit te meaning oCseton 6h Iaceme-XACL, 1951 eset which the dclaatonibeing rade. at asunder: = moranue wane eon |, eee |i Sinai aaa | Rata tokens | caaremas —| amram — 2 “aaa | Poorer (ae &)SCHEDULE ML Nine iat alo Fe Tmowirofsach sues | Daten which ams | Perndtor vheksuct | — Raw ofingeet Pence whan esas wategiveenaiees | “Maswce gen DPCHANKLED [ERDNO. [eFDNO. /SFDNO. aE Tamterah Clas aunt ac Te Tene Trane pe fhe asl Ed ‘uate Sales acai Stan cea Te iris of Fon OTT whee ie aegoun ender ‘Dal Wah Teaecoan was) —Ticanenof wihdawal ar Nation Savings Sec s aituined aad He arcu Uber opetss ths ccna 7 Sigmar fhe dean Verification ober) deslacihat hobo af*ny our kaos edge ndbsiet wha audabove boned eonpetsandisualy tae beirmbeisenon SPAT RSC CRITE EER Slants ofthe decir Nate 1a Greconplee possi. 2 Thedeartnsbuldbe fanisodidpeas 3 “Delcwnidaveresteytbte 2 Seated apc vices riser cat ind ial ly tot ‘© Betwcngnng i yovtaion, hana shoul iy Sneath enon nsdn eran can cpltelnll espe Any psn aig {este i edelaube psc et ste 2th eS, ano coco be pun (inact etx snutobeevadetes nla ges ih ripoxs nrc vishal abel as oe visa enoseer sean wie {Giang teens gern iehcrnthch hl er heoa ana arr bch xeon yore fe IFOR USEBY THE PERSON TO WHOMTHE DECLARATION IS FURNISHED] ‘hewonrcynconoed apuageph Lotte dscentm. __HDFG BANK LTD 2. Daten whic the dectanton van fisted y the 3, Date af cero, dtibation or payment of dUviead withlnval fom aecountnunbe! anderth: Nata Savings Scene 4. Period ia cept of which “vide es eos Aeclaredincrs ting eral pdincome i ceopecof un being cetedor ped 5. Amount of *videndintees or Income in respect of unitwwihirawal fom National Savag. Scieme ‘Me ase maybe, creed pid Phi Bat. ~ ‘Tguie oF parson response To paving the Disclaimer L. Form 15G isto be filled only for Individuals fess than 65 years (if 65 yrs then fill Form ISI), Proprietorship, Society. Associations ‘of Porsoas, Trust, HUF ete ‘TDS Vaiver Will not be marked f FAN detals are not updated on the Bank's rezords ‘TDS waiver will be marked ffom the date of submission ofthis form ‘TDS which has already been deducted will at be refunded back and whick can be sought from Income Tax department ‘A{resi Form 15G needs to be submited n each new Financial Year within the star of the Finarcal Year. Forty ISG needs to be submited in Triplicate Form 15G needs to be submited for every fixed Deposits booked with ban ‘The Bank shall rot be lable for any consequences oF loss arsing due to delay or aon or wrong submission of Form 15G UW fully understand thot wrong quoting of PAN may reult in petal consequences under section 2728 of Income Tax act 1961 and the bank is not responsible for any consequences arising due wrung quoting of PAN