Letter Head

P.T.R. No.

SOCIETY REG. NO.

To,
The Commissioner of Income Tax,
Through the I.T.O.
Subject: -

Application for Exemption u/s 80 G of Income Tax Act, 1961.

Dear Sir,
With reference to the above, we are submitting herewith following documents in triplicate for
purpose of granting eligibility u/s 80G:
1) Application in 10G with Court Fee Stamp amounting to Rs. 5/-,
2) Certified Copy of Constitution of the Trust
3) Copy of Registration Certificate under the Bombay Public Trusts Act 1950,
4) Copy of Certificate of 12A registration under Income Tax Act, 1961
5) Copy of Certificate of last 80 G Approval
6) Copy of PAN / TAN of the Trust:
PAN:
TAN:
7) Details about of PAN / TAN of Trustees
8) The information regarding assessment i.e. Return of Income filed:
Return of Income has been filed upto 31st March 200 . Acknowledgement No.
9) List of donors above Rs. 5000/- for last three years:
There are no persons who have donated above Rs. 5000/- in last three Financial Years.
10) List of persons to whom interest above Rs 2500/- is paid:
There are no persons to whom interest above Rs. 2500/- has been paid in last three Financial
Years.
11) A Certificate in respect of utilisation of fund in India.
12) Details of Present activity of the trust.
13) Declaration that there is no change in the Constitution of Firm.
14) Declaration U/s. 13(1)(c).
15) Letter of Condonation of Delay.
16) The Certificate of Managing Trustee that all the information given is complete, true and
correct.
17) Information in Annexure B with Annexure B.
1

Letter Head
P.T.R. No.

SOCIETY REG. NO.

18) Certified photocopy of Accounts of Trust with Audit Report in Form 10B for last three years.
Kindly do the needful at your earliest, and oblige.
Thank you very much,
Yours truly,
For
Secretary.

ANNEXURE B 1
2

Letter Head
P.T.R. No.

SOCIETY REG. NO.

1.

Name of the trust

2.

Address of the Trust

3.

Date of Creation

4.

Registration Number

Date :

Signature:

Place:

Designation: Srecretary

Letter Head
P.T.R. No.

SOCIETY REG. NO.

THE INFORMATION REGARDING ASSESSMENT

Annexure - B 3
1. Name of the Trust

2. Return of Income is filed

3. Assessment Year

4. Date of Return

5. PAN Number

6. TAN Number

7. Acknowledgment No. of Return :

8. Assessing Officer

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P.T.R. No.

SOCIETY REG. NO.

LIST OF FOUNDER MEMBERS OF

THE TRUST
Annexure B - 4
Sr.No.

Name of the founder Member

Letter Head
P.T.R. No.

SOCIETY REG. NO.

List Of Executive Council & Members

PAN / TAN for the trustees obtained
Sr.No. Name of the Trustee

Address

PAN No.

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P.T.R. No.

SOCIETY REG. NO.

Annexure - B 5
1. Is any Object of Religious Nature or Non Charitable Nature :No.
3.Whether any object is hit by Expl. 3. to Section 80 G :No.

Letter Head
P.T.R. No.

SOCIETY REG. NO.

Annexure B - 6
1. Name of the Trustee

2. Return of Income is filed

3. Assessment Year

4. Date of Return

5. PAN Number

6. TAN Number

7. Acknowledgment No. of Return :

8. Assessing Officer

1. Name of the Trustee

2. Return of Income is filed

3. Assessment Year

4. Date of Return

5. PAN Number

6. TAN Number

7. Acknowledgment No. of Return :

8. Assessing Officer

1. Name of the Trustee

2. Return of Income is filed

3. Assessment Year

4. Date of Return

5. PAN Number

6. TAN Number

7. Acknowledgment No. of Return :

8. Assessing Officer

1. Name of the Trustee

:
8

Letter Head
P.T.R. No.

SOCIETY REG. NO.

2. Return of Income is filed

3. Assessment Year

4. Date of Return

5. PAN Number

6. TAN Number

7. Acknowledgment No. of Return :

8. Assessing Officer

1. Name of the Trustee

2. Return of Income is filed

3. Assessment Year

4. Date of Return

5. PAN Number
6. TAN Number

:
:

7. Acknowledgment No. of Return :

8. Assessing Officer

1. Name of the Trustee

2. Return of Income is filed

3. Assessment Year

4. Date of Return

5. PAN Number

6. TAN Number

7. Acknowledgment No. of Return :

8. Assessing Officer

1. Name of the Trustee

2. Return of Income is filed

3. Assessment Year

4. Date of Return

5. PAN Number

6. TAN Number

7. Acknowledgment No. of Return :

8. Assessing Officer

:
9

Letter Head
P.T.R. No.

SOCIETY REG. NO.

1. Name of the Trustee

2. Return of Income is filed

3. Assessment Year

4. Date of Return

5. PAN Number

6. TAN Number

7. Acknowledgment No. of Return :

8. Assessing Officer

Letter Head
P.T.R. No.

SOCIETY REG. NO.

ANNEXURE B 7

1. If Registered under section 12 (A) of the Income Tax Act, the Registration and date of
Registration:
--

Reg. Sr. No./CIT

2. .Is the trust Registered under section 80 G of the Income Tax Act:
--

Yes

3. The date of order and period of first recognition granted under section 80 G:
Not Applicable
4. Last period of exemption under section 80 G:
-5. If not registered under section, reason for it:
--

NA

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P.T.R. No.

SOCIETY REG. NO.

ANNEXURE B 8
Details of expenditure on Objects for last 3 Financial Years
Sr.
No

Financial Year

Nature of Expenditure

Amount

on Objects

Rs

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P.T.R. No.

SOCIETY REG. NO.

ANNEXURE B 10

1. Is the Income is exempt under section 10 (22), 11,12 ect.?

Yes. Income exempt U/s 11
2. Condition laid down under section 80 G (1) (V) & 12 A are fulfilled.
Yes

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P.T.R. No.

SOCIETY REG. NO.

DECLARTION REGARDING UTILISATION OF FUNDS

We, the undersigned, Trustees of

a Private Charitable Trust

registered with Charity Commissioner (Maharashtra State) under Regn. No.

does

hereby declare that the activities of the Trust are being carried on within India. As such, all the
funds received by the Trust till date has been utilized within India and any funds that shall be
received by the Trust in future shall be utilized within India only.

Date:
Place:

Secretary

Letter Head
P.T.R. No.

SOCIETY REG. NO.

LIST OF PERSONS TO WHOM INTEREST ABOVE RS 2500/- IS PAID.

Sr.
No

Name of the Person

Amount

____________________________ NIL____________________________

Date:
Place:

Secretary

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P.T.R. No.

SOCIETY REG. NO.

CERTIFICATE OF UTILIZATION OF FUND IN INDIA

This is to certify that the total income of the trust for the financial year 200 -200
Rs

/-. Out of the total income an amount of Rs

/- was utilised in India during the

financial year 200-200 as follows

Date:
Place:

Secretary

was

Letter Head
P.T.R. No.

SOCIETY REG. NO.

CERTIFICATE OF UTILIZATION OF FUND IN INDIA

This is to certify that the total income of the trust for the financial year 200 - 200
Rs

/-. Out of the total income an amount of Rs

financial year

/- was utilised in India during the

as follows

1.

Date:
Place:

Secretary

was

Letter Head
P.T.R. No.

SOCIETY REG. NO.

CERTIFICATE OF UTILIZATION OF FUND IN INDIA

This is to certify that the total income of the trust for the financial year 200 - 200 was Rs
Out of the total income an amount of Rs

/-.

/- was utilised in India during the financial year

200 -200 as follows

Date:
Place:

Secretary

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P.T.R. No.

SOCIETY REG. NO.

CONFIRMATION CERTIFICATE

I, the undersigned,

Managing Trustee of

( Reg. No F ) do

hereby declare that to the best of my knowledge and belief, the information furnished in the
application form, declaration and other statement is true, correct and complete, and other
particulars shown therein are truly stated.

Date:
Place:

Secretary

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P.T.R. No.

SOCIETY REG. NO.

DECLARATION
We the trustees of the

( Reg. No F 1545 City name) do hereby declare that

the provisions of Section 13 (I) (c) of the Income Tax Act, 1961 have not been infringed by the
Trust since the date of its creation upto the date of application made for the renewal of exemption
under section 80 G of the Income Tax Act, 1961.
This Declaration is made on this 29th day of November, 2007

Date:
Place:

Secretary

DECLARATION
2

Letter Head
P.T.R. No.

We the trustees of the

SOCIETY REG. NO.

{ Reg. No.

}do here by declare that there has

been no change in the constitution of the trust since the date of its creation upto the date of
application made for renewal for exemption under Section 80 G of the Income Tax Act, 1961.

This Declaration is made on this 29th day of November ,

Date:
Place:

City name

Secretary

Letter Head
P.T.R. No.

SOCIETY REG. NO.

Members to whom benefited above Rs. 5000/- is given.

200 -201
Sr. No.

Name

Amount

1
2

200 -20
Sr. No.

Name

Amount

200 -200
Sr. No.

Name

Amount

1
2
3

Date:
Place:

City name

Secretary

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P.T.R. No.

SOCIETY REG. NO.

Annexure B 10
List of Employees of the Trust
-------------------------------------- --------NIL----------------------------------------------------------------

Date:
Place:

City name

Secretary