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(h)forFormNo.

27C,thefollowingFormshallbesubstituted,namely:
"FORMNo.27C
[Seerule37C]

Declarationundersubsection(1A)ofsection206CoftheIncometaxAct,1961tobemadebyabuyerforobtaininggoodswithoutcollectionoftax
PARTI
1.NameofBuyer(applicant) 2.PANoftheBuyer
INFORMATION:BUYER

3.Flat/Door/BlockNo. 4.NameofPremises 5.***Status(chooseamong1to6)


8.AssessedinwhichWard/Circle
6.Road/Street/Lane 7.Area/Locality 9.AOCode(underwhomassessedlasttime)
AreaCode AOType RangeCode AONo.
10.Town/City/District 11.State
12.PIN 13.LastAssessmentyearinwhichassessed
14.Email 15.TelephoneNo.(withSTDCode)and 16.PresentWard/Circle
MobileNo. 17.PresentAOCode(ifnotsameasabove)
18.JurisdictionalChiefCommissionerofIncometaxorCommissionerofIncometax(if AreaCode AOType RangeCode AONo.
notassessedtoIncometaxearlier)
INFORMATION:GOODS

19.NatureofBusiness/Occupation 20.Purposeofutilizationofgoods(ticktherelevantbox)
Manufacturing,processing,productionof
articlesorthings
21.Natureofgoods[referedtointhetableinsubsection(1)ofsection206C]
Generationofpower

.
**SignatureoftheDeclarant

Declaration/Verification
*I/We.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 goods referred to in Column No. 21 shall not be used for trading purposes. *I/We also, declare that *I/we *am/are resident in India within
themeaningofsection6oftheIncometaxAct,1961.

Place: .. .
Date: .. SignatureoftheDeclarant

PARTII
[Forusebythepersontowhomthedeclarationisfurnished]
1.NameoftheSeller 2.PANoftheSeller

3.Completeaddress
4.TANoftheSeller

5.Email 6.TelephoneNo.(withSTDCode)and
MobileNo. 7.***Status(chooseamong1to6)
8.Dateonwhichdeclarationisfurnished(dd/mm/yyyy)

9.Dateofdebitingoftheamountpayablebythebuyertotheaccountofthebuyerorreceiptoftheamountpayablefromthebuyerincashorbyissueofa
chequeordraftorbyanyothermode(dd/mm/yyyy)

ForwardedtotheChiefCommissionerorCommissionerofIncometax

Place: ..
Date: .
Signatuerofthepersonresponsiblefor
collectingtaxatthetimeofthesaleofthe
goodsreferredtoincolumnno.21ofPartI.

Notes:
1. Thedeclarationshouldbefurnishedinduplicate.
2. *Deletewhicheverisnotapplicable.
3. **IndicatethecapacityinwhichthedeclarationisfurnishedonbehalfofaHUF,AOP,firm,company,etc.
4. ***1=Company;2=Firm;3=AOP/BOI;4=HUF;5=Individual;6=Others
5.
Beforesigningtheverification,thedeclarantshouldsatisfyhimselfthattheinformationfurnishedinthedeclarationistrue,correctandcompleteinallrespects.
Anypersonmakingafalsestatementinthedeclarationshallbeliabletoprosecutionunder277oftheIncometaxAct,1961andonconvictionbepunishable

i) Inacasewheretaxsoughttobeevadedexceedstwentyfivelakhrupees,withrigorousimprisonmentwhichshallnotbelessthan6monthsbut
whichmayextendtosevenyearsandwithfine;

ii) Inanyothercase,withrigorousimprisonmentwhichshallnotbelessthan3monthsbutwhichmayextendtotwoyearsandwithfine.";

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