FORM NO.

15CA [See rule 37BB]

Information to be furnished for payments to a non-resident not
being a company, or to a foreign company
Acknowledgement Number -616957800080724

Part A
To be filled up if the remittance is chargeable to tax under the provisions of the Income-tax
Act,1961 and the remittance or the aggregate of such remittances, as the case may be, does not
exceed five lakh rupees during the financial year
Remitter

Name of remitter DEBABRATA HALDER

PAN of the remitter (if available) ABUPH1845D

TAN of the remitter (if available) -

Complete Address of the remitter FLAT NO.703, E- WING,

MERIGOLD CHS LTD, BLDG
NO.1, BEVERLY PARK , MIRA
ROAD EAST, Thane, BEVERLY
PARK,MIRA ROAD EAST,
THANE, Maharashtra, INDIA -
401107

Email Address of the remitter primeproductions06@gmail.co

m

Phone Number of the remitter 9920048880

Status of remitter Individual

Residential status of remitter Resident

Remittee

Name of recipient of remittance ABREEZ GIFT TRADING EST

PAN of the recipient of remittance, if available -

Complete Address of the recipient of remittance Sulemania, King Abdul Aziz

Road, Alwurud District., Riyadh,
Kingdom of Saudi Arabia, , , ,
Foreign, Saudi Arabia - 12254

Email of the recipient of remittance -

Phone Number of the recipient of remittance -

Country to which remittance is made Saudi Arabia

Remittance

Amount payable before TDS (In Indian Currency) ₹ 75,000

Aggregate amount of remittances made during the financial year ₹ 4,81,000

including this proposed remittance

IFSC DCBL0000039

Name of Bank DEVELOPMENT CREDIT BANK

LIMITED

Name of the Branch of the bank MIRA ROAD (039)

Name of the Authorized dealer Development Credit Bank Ltd.

Branch Address of the Authorized dealer 601 & 602, Tower A, 6th Floor,
Peninsula Business Park,
Senapati Bapat Marg, Lower
Parel (West), Mumbai 400 013.

Proposed date of remittance 08-Jul-2024

Nature of remittance Fabrication Services

Please furnish the relevant purpose code as per RBI Other Business Services
S1006 - Business and
management consultancy and
public relations services

Amount of TDS ₹0

Rate of TDS (%)

Date of deduction -

Verification
I, DEBABRATA HALDER, son/daughter of shailendra nath halder in the capacity of Individual (designation)
solemnly declare that the information given above is true to the best of my knowledge and belief and no relevant
information has been concealed. I further undertake to submit the requisite documents for enabling the Income-
tax authorities to determine the nature and amount of income of the recipient of the above remittance as well as
documents required for determining my liability under the Income-tax Act as a person responsible for deduction
of tax at source.

Name of the person responsible for paying to non-resident DEBABRATA HALDER

Designation of the person responsible for paying to non-resident Individual

IP Address 103.212.140.60

Date 08-Jul-2024

Place Mumbai
 Acknowledgement Number - 616957800080724

Income Tax Form submitted electronically on 08-Jul-2024 11:59:48 AM from IP Address 103.212.140.60 and
verified by DEBABRATA HALDER having PAN/TAN ABUPH1845D on 08-Jul-2024 11:59:44 AM using Electronic
Verification Code TUGZTXNBEI generated through Aadhaar OTP mode.