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On Letter Head




TO WHOMEVER IT MAY CONCERN


This is to certify that:

1. The amounts are payable to me by Six Dee Telecom Solutions Pvt. Ltd. In respect of …………….
2. The amounts will be remitted to us in ……..,… & we are the beneficiary thereof.
3. We are a Tax resident of ………...
4. We do not have any Permanent Establishment/Fixed base in India.
5. I have not stayed nor will we stay in India for a period or periods exceeding in the aggregate 90 days in the relevant Fiscal year as per the condition stated in the relevant article of the treaty.
6. The place of world assessment of our income is ………...
7. No services are rendered in India.
8. In the event there is any income tax demand (including interest) raised in India in respect of this remittance we undertake to pay the demand forthwith and provide Six Dee Telecom Solutions Pvt. Ltd. with all information/documents that may be necessary for any proceedings before Income-Tax/Appellate Authorities in India.
9. We undertake to intimate Six Dee Telecom Solutions Pvt. Ltd. in case any of the facts specified above undergoes a change.

Date: ………………



Yours faithfully,




……………

FORM NO. 10F

[See sub-rule (1) of rule 21AB]


Information to be provided under sub-section (5) of section 90 or sub-section (5) of section 90A of the Income-tax Act, 1961



I……. *son/daughter of Shri……. in the capacity of…… (designation)… do provide the following information, relevant to the previous year 2014 *in my case/in the case

of …………………… for the purposes of sub-section (5) of * section 90/section 90A:-


Sl.No.

Nature of information

:

Details#


(i)
Status (individual; company, firm etc.) of the assessee

(ii)
Permanent Account Number (PAN) of the assessee if allotted

(iii)
Nationality (in the case of an individual) or Country or specified territory of incorporation or registration (in the case of others)

(iv)
Assessee’s tax identification number in the country or specified territory of residence and if there is no such number, then, a unique number on the basis of which the person is identified by the Government of the country or the specified territory of which the assessee claims to be a resident

(v)
Period for which the residential status as mentioned in the certificate referred to in sub-section (4) of section 90 or sub-section (4) of section 90A is applicable

(vi)
Address of the assessee in the country or territory outside India during the period for which the certificate, mentioned in (v) above, is applicable


Cont’d…..

2. I have obtained a certificate to in sub-section (4) of section 90 of sub-section (4) of section 90A from the Government of ……………… (name of country or specified territory outside India)


Signature:……………….


Name:………………

Address:,

Permanent Account Number: ……………….

Verification


I………………. do hereby declare that to the best of my knowledge and belief what is stated above is correct complete and is truly stated.


Verified today the………………. day of……………….………….


……………………………

Signature of the person providing the information

Place: …………………….


Notes :

1. *Delete whichever is not applicable.

2. #Write N.A. if the relevant information forms part of the certificate referred to in sub-section (4) of section 90 or sub-section (4) of section 90A.

 

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