Form 10FB:Certificate of residence for the purposes of section 90 and 90A

Company Name(s): 
Documents: 

FORM NO. 10FB
[See rule 21AB (4)]
Certificate of residence for the purposes of section 90 and 90A

1. Name of the Person
2. Status
3. Permanent Account Number
4. Address of the person during the period of Tax Residency Certificate.
Certificate
It is hereby certified that the above mentioned person is a resident of India for the purposes of Income-tax Act, 1961.
This certificate is valid for the period __________________
Issued on __________ the day of ________, ________.
Name of the Assessing Officer
Designation____________
Seal ______________".