486110000001 Bar Code: IOUTAMLNMIMN) Pa | "FORM NO. 166 [See section 197A(1), 197ACLA) and rule 29C] Declaration under section 197A (1) and section 197A(1A) to be made by an individual or a person (not being ‘a company or firm) claiming certain incomes without deduction of tax. PARTI T, Namie of Assessee (Declarant ZPAN ofthe Assessor 3 Sane 7 Previous year.) 3 Residential Stas (for which declaraticn is being made) &. Flav Door/Block No._] 7. Name of Premises S Road SwreetiLane | 9. ArealLocality TO TowaCity/Distrit | 11. State TZPIN 13. Ennai TH Telephone No. (with STD] 15 (a) Whether assessed to tax under the Yer No Code) and Mobile No. Incomne-tax Act, 1961" mo oOo «b) If yes, latest assessment year for which assessed TS: Entimated income for which tis declaration is made 17. Estimated total income of the PY. ia which income mentioned in coluran 16 to be included TS Details of Form Ne. 156 other than this Torn fled during the previous year, any" Tolal No. of Form No. 150 filed ‘Aggregate amount of income for which Form No. 150 filed 19, Details of income for which the declaration is filed SL | Identification number of relevant | Nature of income | Section under which tax [ Amount of income No. | investment/account, ete. is deductible HDECBANKLID © CUST DD: @FDNO ©FDNO ©EDNO ©EDNO ‘EDNO eDNO ©EDNO Signature of the Declarant? ‘Mandatory : To be filled by the Braneh (Checiaist for Form 18 G (or individual less than 60 years) Thave checked and confirm the below [nick (y or) ‘Customer is less than 60 years (I= 60 yrs then fll Form 18H) PAN No, isupdated in Bank Records against the Cust id of customer ‘Copy of PAN Card attached (if nol updated inthe system) al with jan S ‘Customer has signed in si places (indicated by) CB Flelds marked © sre mandatory tobe fled \ ome / ‘Name of the Fimp Emp. Code ana Emp. Sign Date 423 ea 102016Declaration/¥ eriffeation'? “We. do hereby declare that to the best of “my/our knowledge and belief what is stated above is comect, complete and is truly stated, "I/We declare that the incomes referred to in this forma are not includible in the total income of any other person under sections 60 to 64 of the Income-tax Act, 1961. *L/We further declare that the tax Yon my/our estimated total income including *income/ineomes referred to in column 16 "and aggregate amount of *income/incomes referred to in column 18 computed in accordance with the provisions of the Incomestax Act, 1961, forthe previous year ending on relevant tothe assessment year will be nl. */We also declare that “my/our “incemefincomes referred to in column 16 *and the aggregate amcunt of ‘incomefincomes referred to in column 18 for the previous year ending on relevant tothe assessment year. will not exceed the maxiznurn ammount which isnot chargeable to ineome-tas. Place: =. Signature ofthe Declarant? Date: PARTI [To be fled by the person responsible for paying the income referred to fn cokumn 16 of Part I] T. Name of the person responsible for paying: Unique Identfieation No-™ 3_PAN of the peron | 4 Complete Address STAN ofthe person responsible for paving responsible for paying & Final 7 Telephone Nox Wii STD Code) and MabileNo | S Amount of neome paid” 3 Date on which Declaration is received] 10 Date on which the Income has been paidoredved (DIMAYYY) ODMMYYYY) Place: ‘ : Signature ofthe person respensibe for paying Date the income referred to in colurm 16 of Pat I Bats whichoweris not applicable “As per grotenne of Secon 20BHA(2), to dedaraton under sect Y97A(1) or 171A) shall be val the declarant fis ofr is valé Permanent Account 2Deelereton canbe rsnesoyanjnchail under sect 57H) anda persn emer an a company x armnjunsersectan 197A. “he franca yeartn wn he uame ptt ‘Pleonemerton hs escent tts ert prosios of secton ofthe eome.ax At, 1251 “Pebe menan ved atrted otc incet provon iam Ay, 86 fan Ee ERAT yar Oo a aeENaMeyean acROnG Heyer Besse mertion he amou estnates ota income of the revous year or vich the decaraton is ld ncuding the amount income or ich is ceoralon fs rae "incase any declreton:) norm No. 156 is le bear fing this declaration dung the previous year, meron the a numberof such Form Na, 156 fit along with Ihoaggredate amaurt orinecer oor utter sid Secer saan) have tem ee selva te terrae Shares, sur rber tm Sepa, ecing epst, tonal Sans Senenes ie sae ly rmbt, IVS oe, ‘frat be capaty in ofc he delarcbon fui an behalf of HUF, ADP “Slee sgnna ne eesratorvercaton, me seen shou sens nse at Pe rom aton shes ms om Aue, corect ans complet alrespees. Any ern meting ale statement Inte eecaaton sal be abet peseaon unr secon 27 the neome tax At. 95 ana en eareon be pune Hin cove where tac sought tobe vate exceeds buery-v fash fupees, mith nga IMpscr Met wn re net ess Mesh mons AN WT ay exten Setengesrsantwa the {in ny cmerease wt rigorous Imprisonment onensnal net be ess tan gee mors eur wen may etena too years and ne the petGonreapansiie for payne ream eed ain coun tea Par shal alta wngue lsrahcaten nurver‘s ai fe rom wa, 18Ge0ekeney nen our 4 user ate nara vex aid ego isreteence purer along it thepartule geste tule aah the inme-tae Rules, 1962 nthe TOE sae tt ‘uti tie saneaiater tn caxethe esos asorecevea Pom no 13H rae same quater, eee alt seare sets see runberar Fo N18 “The person reapanie or paying re neome fereEsO A cake 16 a Pat sralinot aecept me aelaraten where he amoure of come OF me nat ren tn subsector (7) er s-secion (1A) ot secon 1874 or he sagregte of he amounts auth come creates eld Ine ne treats ce Fa tung re prea $Seern whl suchineome ote nase exces tu tun smarnnns echarpule ofa. Por decnghe bgt, a requredta Very heen oe Saureuae amour incomes 95 te case maybe repred byte Gecerantn calms 180Bar Code: 48G110000001 WMI aN | "FORM NO. 166 [See section 197A(1), 197A(LA) and rule 29C] Declaration under section 197A (1) and section 197A(1A) to be made by an individual or a person (not being ‘a company or firm) claiming certain incomes without deduction of tax. PARTI T, Nae of Assessee (Declaranil) 72 PAN of the Asseasee™ 3 Stale 4, Previous year(P. (for which declaration is bei ing made) Residential Status 6, Flat/Door/Block No. 7. Name of Premises 8 Road/StreetiLane | 9, ArealLocality 10, TowalCity District Tf. State 12 EIN 13, Emall 14, Telephone No with STD Cade) and Mobile No. TS (a) Whether assessed to tax under the Yes No Income-tax Act, 1961 {b) If yes, latest assessment year for which assessed co oO T6 Estimated income for which this declaration is made Ty. Estimated total income of the P.Y. in which income mentioned in coluran 16 to be included 18 Details of FormNo, 15G other than this fern filed during the previous year, any" Total Ne. of Form No 15G led ‘Aggregate amount of income for which Form No. 150 filed 19, Details of income for which the declaration is filed Si. No. Identification number gf relevant investment/account, ete. Nature of income Section under which tax | Amount of income is deductible HDECBANKLID © CUST ID: @FDNO ©FDNO ENO ©EDNO ‘EDNO 3 0102016 ©EDNO ©EDNO Signature of the Declarant? We undortand your wat —Declaration/¥ eriffeation'? “we. do hereby declare that to the best of “my/our knowledge and belief what is stated above is comect, complete and is truly stated, "L/We declare that the incomes referred to in this form are not includible in the total income of any other person under sections 60 to G4 of the Income-tax Act, 1961. *L/We further declare that the tax Yon my/our estimated total income including *incomesineomes referred to in column 16 "and aggregate amount of "income/incomes referred to in column 18 computed in accordance with the provisions of the Income-tax Act, 1961, forthe previous year ending, on relevant to the assessment year vill be nil. “I/We also declare that *my/our *income/incomes referred to in colurmn 16 *and the aggregate amount of *income/incomes referred to in column 18 for the previous year ending on relevant to the assessment year. ‘will not exceed the maximum arnount which is not chargeable to income-tas. - Place: Signature of the Declarant” Date: PART IT [To be filled by the person responsible for paying the income referred to in column 16 of Part I] T. Name of the person responsible for paying 2 Unique Identification No.™ 3. PAN of the person] 4, Complete Address 3. TAN of the person responsible for paying responsible for paying © Email 7. Telephone No (with STD Code) and MobileNo,_| 8 Amount of come paid” Date on which Declaration is received ] 10. Date on which the mcome has been parUcredited (DIMM) DDMMYYYY) Place: ee . Signature of the person respensible for paying Date: the income referred to in column 16 of Part I "als wticheweris not applicable “As per provtenne of Secon 20B8A(2), to declaration under sec 97AI1) or 171A) shall be inva the declarant fie ofa is valé Permanent Account 2Declereton can be isnesoyanjnahail under seeton 1974) anda person emer an a company x armnjunser seca 197A). “he franca yeartn ymin ne came ptt, ‘Pleone meron hs ence tis rine pions of scton 6 ofthe eome.tax At, 1261 “Pek mena ved attend otc ioe provslon iam Ay, 86 fay te NERA yar aeENoMeyean faceOng he yen Besse mention he anouT estnat oe ncome of the revous year or vrich the decaraton Is ld including the amount income or ich is ceoralon fs rade "incase any dectareton:) norm No. 156 is le befor fing this declaration dung the previous year, enon the al number of such Form Na, 156 fit along wih tho aggredate aurt ornecerovor wt ald Secer sans) he tear eo seer te tenure Shares, sun ranber fm Sepa, ecling Sept tonal Savings Sehenes Me sue ly rb, MIS oc, ‘trate be capaty i oFich he delarcbon stuns on behalf of HUF, ADP “Shere sgnn ne eevsratonvercaton, te seer sreu senry nse at Pe rom atonnshesin ns om Bue, corect ans complet alrespees. Any person meting alse sstement te cecaton shal be abe preesann ner secon 27 othe neomeax At, 195 ana oneareton be punenle Hin cove where tac sought tobe vate exceeds berg fash fupees, mith nga IMprscrMert wn re et ess Mesh wos A WT ay exer 2 Sitengears anda te {iin sheer ease wt rigorous mprsonment onen shal et be ess an gee morta vie wen may etenato wo year anaetn ne “he pettonreapansit or payne reame eee ain soma Yeo Par shal alta ungue lsraicaten nurberts ai fe Pom Wa, 186 e0ekoney nen our 4 ure ate nana yea epatisreteence nureer alongwith the parle geste tule Aah othe inex Rules, 1962 nite TOE sam fut tie saneciatern cave the prsonnesasoreevearom no 13H nae sane queer, sees alsa sets seal runberarFom Nos “The person reapanie or paying re neome ferenesO A cour 16 a Pat saline accept ne Betaratcn where he amoure oF nome OF me nat rere tN subsection (1) s-secton (14) of secon 1874 or Re sagrepteo he amounts auth MoM creates eld Ine ne treats ce Fa ug he prea $Seern whe schineome oe nase oxen tu atu smartness fa, Por decnghe egw, a requted avery neon os Sagregas amouréctincomes, 9: te ase maybe reported by i Gecerantn calms 18 0 Disclaimer 1. Form 15G isto be filled only Zor Incividhal less than 60 years ('>~60 yrs then fll Form 18H), Proprietorship, Society, Ascodiations of Persons, Thus, HUF ete "TS waiver will not be marked if PAN details are not updated on the Bank's records "TDS waiver will be marked from the date of submission ofthis form “TDS which has already been deshcted will not be refunded back and which can be sought from Income Tas department ‘Affesh Fou 15G needs to be submitted in each new Financial Year within the start ofthe Kinancial Yeas Form 156 needs tobe submitted in Thiplicate Form 154 needs to be submitted for every tixed Deposits booked with bank “The Bank shall not be lible for any consequences ot loss atising due to delay or non or wrong submission of Form 154 1WWe fully understand that wrong quoting of PAN may result in penal consequences under sedion 2728 of lacome Tax act 1961 and the bankis not responsible for my consequences arising due wrong quoting of PANBar Code 486110000001 WMI AN | "FORM NO. 166 [See section 197A(1), 197A(LA) and rule 29C] Declaration under section 197A (1) and section 197A(1A) to be made by an individual or a person (not being ‘a company or firm) claiming certain incomes without deduction of tax. PARTI T, Nate of Assesses (Declaraniy 2 PAN of the Assessee™ 3 Stale 4, Previous year(P. (for which declaration is bei ing made) 3 Residential Status 6. FlatDoor/Block No. 7. Name of Premises 8, Road/StreetiLane | 9. ArealLocality 10. TowalCity District Ti. State 12 EIN 13, Emall 14, Telephone No. with STD Cade) and Mobile No. TS (a) Whether assessed to tax under the Yes No Income-tax Act, 1961 «b) If yes, latest assessment year for which assessed co oO To Estimated income for which this declaration is made Ty. Estimated total income of the P.Y. in which income mentioned in coluran 16 to be included 18 Details of Form No, 15G other than this fern filed during the previous year, I any’ Total No. of FormNo 15G liled ‘Aggregate amount of income for which Form No. 150 filed 19, Details of income for which the declaration is filed si. No. Identification number gf relevant investment/account, ete. Nature of income Section under which tax | Amount of income is deductible HDECBANELID © CUST ID: @FDNO ©FDNO ENO ©EDNO ‘EDNO 3 0102016 NO ©EDNO Signature of the Declarant? ‘We undortand your wat a (S )Declaration/V erifieation'? “we. do hereby declare that to the best of “my/our knowledge and belief what is stated above is comect, complete and is truly stated, "I/We declare that the incomes referred to in this form are not includible in the total income of any other person under sections 60 to G4 of the Income-tax Act, 1961. *l/We further declare that the tax "on my/our estimated total income including *income/ineomes referred to in column 16 "and aggregate amount of *income/incomes referred to in column 18 computed in accordance with the provisions of the Income-tax Act, 1961, for the previous year ending, on relevant to the assessment year vill be nil, “I/We also declare that *my/our inceme/incomes referred to in column 16 *and the aggregate amount of *income/incomes referred to in column 18 for the previous year ending on relevant to the assessment year. ‘will not exceed the maximum annount which is not chargeable to income-tas. - Place: Signature of the Declarant” Date: PART IL [To be filled by the person responsible for paying the income referred to in column 16 of Part I] T. Name of the person responsible for paying 2 Unique Identification No.™ 3 PAN of the person] 4 Complete Address 3. TAN of the petson responsible for paying responsible for paying © Email 7. Telephone No. @wilh STD Code) and MobileNo, | & Amount of come paid” Date on which Declaration is received ] 10. Date on which the income fas been pardcredited (DIMM) (DDMMYYYY) Place: saan : Signature of the person respensible for paying Date: the income referred to in column 16 of Part I Bats whicheweris not apsicable “As per grotenne of Secon 20BHA(2), to dedaraton under seclen 97A(1) or 171A) shall be val the declarant fis ofr is valé Permanent Account 2Declereton canbe rusnesoyaninehail under seeton 97H) anda persn omer man a company x afinjunser sec 197A). “ihe franca year tn nih ne came ptt ‘Pleone meron hs escent tts ern prions of secton ofthe eons ax, 1951 “Pesce mented aurea ice he povlonFiam Ay, 86 fay Ee AERA yar oo a tEAM yea aceOnG Heyer Besse mertion he anouT estinates ota ncome of the revous year or vich the decaraton is led ncuing the amount income or wich hs ceoralon fs rae "incase any dectareont:) norm No. 156 is le bear fing this declaration dung the previous year, erton the a number of such Form Na, 186 fit along with Iho aggredate amaurt oinecer oor wtvn sid Seceraan(s) hae tear Nee seer te tenure shares, sun ranber fem Sepa, ecling eps tonal Sangs Sehenes, Me sue ely rmbt, MES oc, ‘trate capaty in ofich he delarcbn fuses an behalf of HUF, ADP, “Slee cgnn ne eeisratorvercaton te secon shou sens nse at Pe romatonmshesin om Bue, covet ans complet alrespees. Any eran meting alse tenant Inte eecaaton sal be abe preesann unr secon 27 the neomeax Act, 95 anaeneareton be punenie Hin cove where tac sought tobe evade exceeds buery-v fash fupees, mith nga. IMpscret wn el net ess Mesh mons AH WT My exten Sctengesrsandwa te {in ny emer ease wt rigorous mprsonment onen shal et be ess an gee morta ez wen may exten too year ander ne he petonreapansiie or payin ine reame eed ain coun te cf Par shal acta uvgue bare nuver sai fe Pom wa, 18G e0eeney nen our ‘ure atin nana yer and ego isreteence purer along it thepartulaegrostees rule Aah ihe inamne-tae Rules, 1962 nthe TOE sae fut tie saneciater incase the preonnesasorecevea rom no TSH rahe sane quater, eee lsat sets seal ranberarFom Na18s “The petsen responsive or paying re neome freEsO A came 16 a Pa sralinot accept ne aetaraten where he moire of nome OF Me na ren tN usecton (7) er s-scton (1A) ot secon 1874 or he sagregte oe amounts a auth come cess eld Ine nO treats ce Fa aug he prea $Seerm whol schineome ote nse exces tu run smarnnn necharpeuiofa. Por decnghe bgt, rs requredta very heen os Sauregals amour tincomes 35 te ase maybe repred bye Gecerantn calms 180 Disclaimer 41. Fou 15G isto be filled only Zor Incividhal less than 60 years (60 yrs then fll Form 1SH), Proprietorship, Society, Astociations of Persons, Thus, HUF ete "TDS waiver will not be marked if PAN details are not updated on the Bank's records "TDS waiver will be marked from the date of submission ofthis form “TDS which has already been deshcted will not be refunded back and which can be sought from Income Tas department Afiesh Foum 15G needs to be submitted in each new Financial Year within the start ofthe Kinancial Year Form 156 needs tobe submitted in Thiplicate Form 154 needs to be submitted for every tixed Deposits booked with bank "The Bank shall not be liable for any consequences ot loss atising due to delay or non or wrong submission of Form 154° 1WWe fully understand that wrong quoting of PAN may result in penal consequences under sedion 2728 of lacome Tax act 1961 and the bank is not responsible for my consequences arising due wrong quoting of PAN