[See section 197A(1), 197A(1A) and rule 29C] Declaration under section 197A(1) and section 197A(1A) of the

Income-tax Act, 1961 to be made by

an individual or a person (not being a company or firm) claiming certain receipts without deduction of tax.
PART I
SCHEDULE III (Details of the sums given by the declarant on interest)
SCHEDULE I (Details of shares, which stand in the name of the declarant and beneficially owned by him)
No. of Shares Class of shares & face value
of each share
Total value of shares Distinctive Numbers of the shares
SCHEDULE II (Details of the securities held in the name of declarant and beneficially owned by him)
Description of securities Number of securities
Date(s) of securities (dd/mm/yyyy) Amount of securities (Rs.) Date(s) on which the securities were acquired by the declarant(dd/mm/yyyy)
Name and address of the person to whom the sums
are given on interest
Housing Development Finance Corporation Limited, Ramon House,
H T Parekh Marg, 169 Backbay Reclamation, Mumbai 400 020.
SUDIP SETT
2. PAN of the Assessee
BINOD BIHAR
2ND FLOOR FLAT B-4 ,BL-B
159 MOTIJHEEL AVENUE
KOLKATA-700074
Date(s) on which the shares were
acquired by the declarant(dd/mm/yyyy)
1.Name and Address of Assessee (Declarant)
Regd.Office :
Declaration/Verification
3. Assessment Year (for which declaration is being made)
6. #Status
7. Assessed in which Ward/Circle
10. AO Code(under whom assessed last time)
AISPS6339J
2015-2016
Individual
Area Code AO TypeRange Code AO No.
14. Last Assessment Year in which assessed :
Email
Telephone No. 9883015538 Mobile No.
17. Present Ward/Circle
18. Residential Status ( within the meaning of Section 6 of the Income Tax Act,1961) Resident
19. Name of Business/Occupation : 20. Present AO Code (if not same as above)
21. Jurisdictional Chief Commissioner of Income-tax or Commissioner
of Income-tax (if not assessed to Income-tax earlier)
Area Code AO TypeRange Code AO No.
Dividend from shares referred to in Schedule I Interest on securities referred to in Schedule II
Interest on sums referred to in Schedule III Income from units referred to in Schedule IV
The amount of withdrawal referred to in section 80CCA(2)(a) from National Savings Scheme referred to in ScheduleV
23. Estimated total income of the previous year in which income mentioned in Column 22 is to be included
24. Details of investments in respect of which the declaration is being made :
** Signature of the declarant
X
Place : __________________ Date : ________________
X
*I/We SUDIP SETT do hereby declare that to the best of *my/our knowledge and belief what is stated above is correct, 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 u/s 60 to 64 of the Income-tax Act, 1961. *I/We further, declare that the tax *on my/our estimated total income, including *income/incomes referred to
in Column 22 above, computed in accordance with the provisions of the Income-tax Act, 1961, for the previous year ending on 31/03/2015 relevant to the assessment year 2015-2016 will be nil. *I/We also,
declare that *my/our *income/incomes referred to in Column 22 for the previous year ending on 31/03/2015 relevant to the assessment year 2015-2016 will not exceed the maximum amount which is not
chargeable to income-tax.
25796602
Rs.
Signature of the declarant
: :
:
Other Deposits
FORM NO. 15G Customer No. 31289312 /
1
Name and address of the Mutual Fund Number of Units Class of units and face value of each unit Distinctive Numbers of units Income in respect of units
SCHEDULE IV (Details of the mutual fund units held in the name of declarant and beneficially owned by him)
SCHEDULE V (Details of the withdrawal made from National Savings Scheme)
Particulars of the Post Office where the account under the National Savings Scheme is
maintained and the account number
Date on which the account
was opened(dd/mm/yyyy)
The amount of withdrawal
from the account
Deposit No
Amount of sums given
on interest
Date on which the sums were given
on interest(dd/mm/yyyy)
ROI
(% p.a.)
CC/7120367
CC/7259078
CC/7259085
CC/7259164
CC/7259126
CC/7259133
CC/7259803
30,002
25,000
30,000
65,000
70,000
80,000
40,000
10.00
10.00
10.00
10.00
10.00
10.00
10.00
24/09/2011
21/01/2012
21/01/2012
21/01/2012
21/01/2012
21/01/2012
21/01/2012
Period for which sums were given on interest
24/09/2011
21/01/2012
21/01/2012
21/01/2012
21/01/2012
21/01/2012
21/01/2012
24/06/2014
21/10/2014
21/10/2014
21/10/2014
21/10/2014
21/10/2014
21/10/2014
Deposit Date Maturity Date
Product
CIAM
CIAM
CIAM
CIAM
CIAM
CIAM
CIAM
22. Estimated total income from the sources mentioned below : (Please tick the relevant box )
2
PART II [FOR USE BY THE PERSON TO WHOM THE DECLARATION IS FURNISHED]
For Housing Development Finance Corporation Limited
1. Name of the person responsible for paying the income referred to in Column 22 of Part I
5. Email 7. Status : Company
8. Date on which Declaration is Furnished (dd/mm/yyyy)
Forwarded to the Chief Commissioner or Commissioner of Income-tax.......................................
: Housing Development Finance Corporation Limited.
Rs.21,671.41
01/04/2014 TO 31/03/2015
Notes :
1. The declaration should be furnished in duplicate. 2. *Delete whichever is not applicable.
3. #Declaration can be furnished by an individual under section 197A(1) and a person (other than a company or a firm) under section 197A(1A).
4. **Indicate the capacity in which the declaration is furnished on behalf of a HUF, AOP, etc.
5. Before signing the declaration/verification , the declarant should satisfy himself that the information furnished in this form is true, correct and complete in all respects. Any person making a false
statement in the declaration shall be liable to prosecution under 277 of the Income-tax Act, 1961 and on conviction be punishable-
i ) In a case where tax sought to be evaded exceeds twenty-five lakh rupees, with rigorous imprisonment which shall not be less than 6 months but which may extend to seven years and with fine;
ii) In any other case, with rigorous imprisonment which shall not be less than 3 months but which may extend to two years and with fine.
6. The person responsible for paying the income referred to in column 22 of Part I shall not accept the declaration where the amount of income of the nature referred to in sub-section (1) or sub-section (1A) of
section 197A or the aggregate of the amounts of such income credited or paid or likely to be credited or paid during the previous year in which such income is to be included exceeds the maximum amount
which is not chargeable to tax.";
2. PAN of the person indicated in Column 1 of Part II
4. TAN of the person indicated in Column 1 of Part II 6. Tel / Mobile No : 1800-22-2022
9. Period in respect of which the income has been paid/credited
10. Amount of income paid 11. Date on which the income has been paid/credited(dd/mm/yyyy)
3. Complete Address AAACH0997E :
:
:
:
Place : __________________ Date : ________________
MUMH00305E
:
: deposits@hdfc.com
Ramon House, H T Parekh Marg, 169 Backbay Reclamation, Mumbai 400 020.
:
: As Above
FORM NO. 15G Customer No. 31289312
2
/
2
Dear Depositor,

Sub: Income Tax deduction at Source - Form 15G
In accordance with Section 194A of the Income Tax Act 1961, we are required to deduct tax at source from the interest to be
paid/credited on your deposits with us. In case the tax on your estimated total income for the Financial Year 2014-2015 is nil,
you may submit this declaration in Form No 15G to avoid deduction of tax at source from the interest to be paid/credited on
your deposits.
Please Note that Central Board of Direct Taxes(CBDT) vide Notification No 11 of 2013, has revised the format of the
declaration in Form No. 15G from April 1, 2013. As per the revised format you are now required to furnish your estimated total
income for the financial year 2014-2015 in Column No 23 of Part I.
Please fill in the required details wherever applicable and submit the declaration to us at the earliest, to enable us to
Pay/Credit interest on your deposits without deduction of tax at source. Please ignore, if you are liable to pay Income tax for
the Financial Year 2014-2015. For any further clarification, kindly contact us on 1-800-222022.
Yours Faithfully,
HDFC Deposits