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FORM No. 15G
[See Rule 29C]
Declaration under sub-sections (1) and (1A) of section 197A of the Income-tax Act, 1961, to be made by an individual or a person (not being a company or a firm) claiming certain receipts without deduction of tax
I/We* DEEPU GUPTA son / daughter / wife of resident of WB-13-C WB-BLOCK SHAKARPUR, , , DELHI, NEW DELHI, 110092, INDIA @ do hereby declare.
1.

*that I am a shareholder in
(name and address of the company) and the shares in the said company, particulars of which are given in Schedule I below, stand in my name and are beneficially owned by me, and the dividends therefrom are not includible in the total income of any other person under sections 60 to 64 of the
Income-tax Act, 1961;
OR
*#that the securities or sums, particualrs of which are given in Schedule II or Schedule III or Schedule IV below, stand in *my/our name and beneficially belong to *me/us, and the *interest in respect of such securities or sums and/or income in respect of units is/are not includible in total income of any other person under sections 60 to 64 of the Income-tax Act, 1961;
OR
*that the particulars of my account under the National Savings Scheme and the amount of withdrawal are as per the Schedule V below;

2.

that *my/our present occupation is

;

3.

that the tax on *my/our estimated total income, including*the dividends from shares referred to in Schedule I below; and/or *#interest on securities, interest other than interest on securities and/or income in respect of units, referred to Schedule II, Schedule III and/or
Schedule IV below; and/or *the amount referred to in clause(a) of sub-section (2) of section 80CCA, mentioned in Schedule V below, computed in accordance with the provisions of the Income-tax Act, 1961, for the previous year ending on .................................................... relevant to the assessment year .................... -