Income-tax Rules, 1962

FORM NO. 60
[See second proviso to rule 114B]
Form for declaration to be filed by an individual or a person (not being a company or firm) who
does not have a permanent account number and who enters into any transaction specified in rule
114B
First Name Bolem
1 Middle Name
Surname Venkateswara Rao
2 Date of Birth/ Incorporation of declarant 0 1 0 1 1 9 6 6
3 Father’s Name (in case of individual)
First Name
Middle Name
Surname
Flat/ Room No. Floor No.
4 5

Name of premises Block Name/No.

6 7

Road/ Street/ Lane Area/ Locality

8 4-124 Goudapalem Garikaparru Garikaparru 9
Garikaparru
Town/ City District State
10 11 12
Krishna Andhra Pradesh
Pin code Telephone Number (with STD code) Mobile Number
13 14 15
521165 9640649504
16 Amount of transaction (Rs.) 1250000
17 Date of transaction

18 In case of transaction in joint names, number of persons involved in the transaction 2

Mode of transaction: Cash,

Cheque, Card, Draft/Banker’s Cheque,
19
Online transfer, Other
20 Aadhaar Number issued by UIDAI (if available) XXXXXXXX5848
 21 If applied for PAN and it is not yet generated enter date of
application and acknowledgement number

If PAN not applied, fill estimated total income (including income of spouse, minor child etc. as per
22
section 64 of Income-tax Act, 1961) for the financial year in which the above transaction is held

a Agricultural income (Rs.)

b Other than agricultural income (Rs.)

Details of document being produced

Name and address of the
23 in support of identify in Column 1 01 XXXXXXXX5848 authority issuing the document
(Refer Instruction overleaf)

Details of document being produced

Name and address of the
24 in support of address in Columns 4 to 01 XXXXXXXX5848 authority issuing the document
13 (Refer Instruction overleaf)

Verification
I, Bolem Venkateswara Rao do hereby declare that what is stated above is true to the best of my
knowledge and belief. I further declare that I do not have a Permanent Account Number and my/ our
estimated total income (including income of spouse, minor child etc. as per section 64 of Income-tax Act,
1961) computed in accordance with the provisions of Income-tax Act, 1961 for the financial year in
which the above transaction is held will be less than maximum amount not chargeable to tax.
Verified today, the 14 day of March 2024

Place:Vijayawada (Signature of declarant)

Note:

1. Before signing the declaration, 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 section 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 six 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 three months but which
may extend to two years and with fine.
 2. The person accepting the declaration shall not accept the declaration where the amount of
income of the nature referred to in item 22b exceeds the maximum amount which is not chargeable
to tax, unless PAN is applied for and column 21 is duly filled.

Instruction:
(1) Documents which can be produced in support of identity and address (not required if applied for
PAN and item 20 is filled): -
Document Proof of Proof of
Sl. Nature of Document
Code Identity Address
A For Individuals and HUF
1. AADHAR card 01 Yes Yes

2. Bank/Post office passbook bearing photograph of the person 02 Yes Yes

3. Elector’s photo identity card 03 Yes Yes

4. Ration/Public Distribution System card bearing 04 Yes Yes

photograph of the person
5. Driving License 05 Yes Yes
6. Passport 06 Yes Yes
7. Pensioner Photo card 07 Yes Yes
National Rural Employment Guarantee Scheme
8. 08 Yes Yes
(NREGS) Job card

9. Caste or Domicile certificate bearing photo of the person 09 Yes Yes

Certificate of identity/address signed by a Member of

Parliament or Member of Legislative Assembly or
10. 10 Yes Yes
Municipal Councillor or a Gazetted Officer as per annexure
A prescribed in Form 49A

Certificate from employer as per annexure B prescribed in

11. 11 Yes Yes
Form 49A
12. Kisan passbook bearing photo 12 Yes No
13. Arm’s license 13 Yes No

Central Government Health Scheme

14. 14 Yes No
/Ex-servicemen Contributory Health Scheme card

Photo identity card issued by the government./ Public Sector

15. 15 Yes No
Undertaking
16. Electricity bill (Not more than 3 months old) 16 No Yes

17. Landline Telephone bill (Not more than 3 months old) 17 No Yes

18
 18. Water bill (Not more than 3 months old) 18 No Yes
Consumer gas card/book or piped gas bill (Not more than 3
19. 19 No Yes
months old)

20. Bank Account Statement (Not more than 3 months old) 20 No Yes

21. Credit Card statement (Not more than 3 months old) 21 No Yes

22. Depository Account Statement (Not more than 3 months old) 22 No Yes

23. Property registration document 23 No Yes

24. Allotment letter of accommodation from Government 24 No Yes

25. Passport of spouse bearing name of the person 25 No Yes

26. Property tax payment receipt (Not more than one year old) 26 No Yes

B For Association of persons (Trusts)

Copy of trust deed or copy of certificate of registration issued by 27 Yes Yes
Charity Commissioner

For Association of persons (other than Trusts) or Body of

C
Individuals or Local authority or Artificial Juridical Person)

Copy of Agreement or copy of certificate of registration issued by

Charity commissioner or Registrar of Cooperative society or any
other competent authority or any other document originating from 28 Yes Yes
any Central or State Government Department establishing identity
and address of such person.

(2) In case of a transaction in the name of a Minor, any of the above mentioned documents as proof of
Identity and Address of any of parents/guardians of such minor shall be deemed to be the proof of
identity and address for the minor declarant, and the declaration should be signed by the
parent/guardian.
(3) For HUF any document in the name of Karta of HUF is required.
(4) In case the transaction is in the name of more than one person the total number of persons should be
mentioned in Sl. No. 18 and the total amount of transaction is to be filled in Sl. No. 16.
In case the estimated total income in column 22b exceeds the maximum amount not chargeable to tax the
person should apply for PAN, fill out item 21 and furnish proof of submission of application.