“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
1 First Name M d Date of Birth / Incorporation of
2
declarant
Middle A s l a m D D M M Y Y Y Y
Name

Surname A n s a r i 2 1 0 8 2 0 0 5

3 Father’s First Name

Name M d
(in case of
individual) Middle
Name

Surname
A y u b A n s a r i
4 Flat / Room No. 5 Floor
No.
6 Name of premises 7 Block SONAMATI ROAD
Name /
No.
8 Road / Street / Lane 9 Area/ ISLAMPUR
Locality
10 Town / City Islampur 11 District Uttar Dinajpur 12 State West Bengal

13 Pin Code 733202 14 Telephone Number (with STD code) 15 Mobile Number 9082789278

16 Taxpayer identification Number in the

country of residence (if covered by
third proviso)
17 Amount of 19 In case of transaction in joint
transaction (Rs.) names, number of persons
involved in the transaction
18 Date of transaction D D M M Y Y Y Y

20 Mode of transaction: (Please Cash Cheque Card Draft / Online Other

tick appropriate box) Banker’s Transfer
Cheque
21 Aadhaar Number issued by UIDAI (if available) R 3 2 8 8 0 3 6 5 8 7 2
22 If applied for PAN and it is not yet generated enter D D M M Y Y Y Y Acknowledgment Number
date of application and
acknowledgement number
23 If PAN not applied, fill estimated total income (including income of spouse, minor child etc. as per 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.) 2 T o 5 L a k h s
C i Income chargeable to tax
(for a foreign company)
ii Income not chargeable to
tax (for a foreign
company)
24 Details of document being produced in support Document code Document identification Name and address of the
of Identify in Column 1 number authority issuing the document
(Refer Instruction overleaf)

25 Details of document being produced in Document code Document identification Name and address of the
support of Address in Columns 4 to 13 number authority issuing the document
(Refer Instruction overleaf)

Verification
I, Md Aslam Ansari son/ daughter/ wife** of Shri Md Ayub Ansari , solemnly declare that to the best of my knowledge and belief, the information given in this
application and documents, if any, accompanying it are correct and complete and particulars shown therein are truly stated.

2. I further declare that I do not have a Permanent Account Number and

(i) my/our/applicant’s 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, or
(ii) the applicant is a foreign company covered by the third proviso to Rule 114B and does not have any income chargeable to tax in India.
3. I also declare that I am making this application for _____________________ in my capacity as __________ (designation) and I am competent to make this
application and verify it. [if applicable]

Verified today, the 24 - 06 day of 2024 .

Place: Thane

(Signature of declarant)

Kotak Mahindra Bank Ltd.CIN: L65110MH1985PLC038137

Registered Office: 27 BKC, C 27, G Block, Bandra Kurla Complex, Bandra (E), Mumbai - 400 051.
www.kotak.com
KMBL/Jan -2016/V 1.01

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 Incometax Act, 1961
and on conviction be punishable,
(i) in a case where tax sought to be evaded exceeds twentyfive 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.

Kotak Mahindra Bank Ltd.CIN: L65110MH1985PLC038137

Registered Office: 27 BKC, C 27, G Block, Bandra Kurla Complex, Bandra (E), Mumbai - 400 051.
 www.kotak.com
KMBL/Jan -2016/V 1.01

Instructions to the form:

1) Documents which can be produced in support of identity and address (not required if applied for PAN and item 20 is filled): -
Sl. Nature of Document Document Proof of Proof of
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 photograph of the person 04 Yes Yes

5. Driving License 05 Yes Yes

6. Passport 06 Yes Yes

7. Pensioner Photo card 07 Yes Yes

8. National Rural Employment Guarantee Scheme (NREGS) Job card 08 Yes Yes

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

10. Certificate of identity/address signed by a Member of Parliament or Member of Legislative Assembly 10 Yes Yes
or Municipal Councillor or a Gazetted Officer as per annexure A prescribed in Form 49A
11. Certificate from employer as per annexure B prescribed in Form 49A 11 Yes Yes

12. Kisan Passbook bearing photo 12 Yes No

13. Arm’s license 13 Yes No

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

15. Photo identity card issued by the government./ Public Sector Undertaking 15 Yes No

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. Water bill (Not more than 3 months old) 18 No Yes

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

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 Charity Commissioner 27 Yes Yes
C For Association of persons (other than Trusts) or Body of Individuals or Local authority or Artificial
Juridical Person)
Copy of Agreement or copy of certificate of registration issued by Charity commissioner or Registrar of 28 Yes Yes
Cooperative society or any other competent authority or any other document originating from any
Central or State Government Department establishing identity and address of such person.
 Kotak Mahindra Bank Ltd.CIN: L65110MH1985PLC038137
Registered Office: 27 BKC, C 27, G Block, Bandra Kurla Complex, Bandra (E), Mumbai - 400 051.
www.kotak.com
KMBL/Jan -2016/V 1.01

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.
5) 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.
6) Transaction code and type should be selected from the below list only:

Kotak Mahindra Bank Ltd.CIN: L65110MH1985PLC038137

Registered Office: 27 BKC, C 27, G Block, Bandra Kurla Complex, Bandra (E), Mumbai - 400 051.
www.kotak.com
KMBL/Jan -2016/V 1.01