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194N Declaration Form

This document is a declaration under section 194N of the Income Tax Act for filing income tax returns with Fincare Small Finance Bank. It includes details such as PAN, financial year, assessment year, and account holder information, along with a declaration of having filed income tax returns for specified previous years. The signatory also agrees to indemnify the bank for any false information provided.

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41 views2 pages

194N Declaration Form

This document is a declaration under section 194N of the Income Tax Act for filing income tax returns with Fincare Small Finance Bank. It includes details such as PAN, financial year, assessment year, and account holder information, along with a declaration of having filed income tax returns for specified previous years. The signatory also agrees to indemnify the bank for any false information provided.

Uploaded by

abhijitsarkar0908
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DECLARATION U/S 194N OF INCOME TAX ACT

To, Date:
The Branch Manager,
Fincare Small Finance Bank Ltd
____________ Branch
Declaration with respect to filing of income tax returns

PAN NO

Financial Year (FY) 2021-22

Assessment Year (AY) 2022-23

Customer ID

Name of Customer
Category of account holder:

 Government
 Banking company
 Co-operative society engaged in carrying on the business of banking
 Post office
 Business correspondent of a banking company or co-operative society engaged in carrying on the
business of banking, in accordance with the guidelines issued in this regard by the Reserve Bank of
India under the Reserve Bank of India Act, 1934

 White label automated teller machine operator of a banking company or co-operative society engaged
in carrying on the business of banking, in accordance with the authorization issued by the Reserve Bank
of India under the Payment and Settlement Systems Act, 2007
 Others
Declaration for the purpose of tax deduction at source (TDS) under section 194N of the Income-tax
Act, 1961 on cash withdraw
I / we declare that the following account (s) are held by me / us with Fincare Small Finance Bank Ltd
Sl. No. Name of the account holder (s) Account Number (s) Nature of account (s)

1.

2.

3.
Declaration:
This is to declare that I/ we have filed Income Tax Returns under section 139(1) of the Act for following PY’s
relevant to respective AY’s (√ Tick as applicable):
FY 2019-20 (AY 2020-21)
FY 2018-19 (AY 2019-20)
FY 2017-18 (AY 2018-19)

I / we were not liable to file the Income Tax Return for below mentioned immediately preceding Financial
Year/s relevant to the year of declaration as mentioned above:
FY 2019-20 (AY 2020-21)
FY 2018-19 (AY 2019-20)
FY 2017-18 (AY 2018-19)

 I/we have enclosed the acknowledgements for having filed the income tax returns for the aforesaid FY’s.

 I / we undertake to furnish, promptly, proof of filing the Returns or any further information that may be
sought by the Bank in support of above declaration.
I / we further declare that information furnished above is correct. In case any part of the above declaration
is untrue / false, or the proof were not furnished within reasonable time, we undertake to indemnify Fincare
Small Finance Bank Limited for all costs and damages including interest, penalty, etc. and the bank shall
be eligible to recover the amount from the bank account

Yours Sincerely,

Signature:______________

Name: _________________

(Authorized signatory in case of non-individual)

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