FORM NO. 30C
[See rule 43]
Form for furnishing the details under section 230(1A)of the Income-tax Act, 1961
To
[Designation of the Prescribed Authority]
Sir,
I give below the necessary particulars as required under sub-section (1A) of section 230:
1. Full Name (in Block letters) :
2. Present Address :
3. Permanent Address :
4. Name of father/husband :
5. Nature of business/profession in India :
6. The PAN allotted under section 139A
Or
My total income is not chargeable to income-tax (certificates as per annexure)
Or
I am not required to obtain a PAN under the Income-tax Act, 1961 (certificate as per annexure)
7. The purpose of visit outside India :
8. Estimated period of stay outside India :
9. Passport No./Emergency Certificate No
(a) Issued on (date)
(b) From (place)
I declare that to the best of my knowledge and belief, the information furnished is correct and truly stated.
Place : ________________ Yours faithfully
Date :_________________
(Applicant)
Delete whichever is not applicable.

ANNEXURE

Certificate to be furnished by a person domiciled in India whose total income is not chargeable to income-tax or who is not required to obtain a PAN under
the Income-tax Act

I_______________________________son/daughter/wife of
________________________resident of
__________________________________________________do hereby certify that:
(a) No permanent account number has been allotted to me under the provisions of section 139A of the Income-tax Act, 1961;
or
(b) My total income computed in accordance with the provisions of the Income-tax Act, 1961 is not chargeable to tax;
or
(c) I am not required to obtain a permanent account number under the provisions of Income-tax Act, 1961.
(Signature of the person giving the certificate)
Name (in Block letters)
Address
Verification
I___________________________________do hereby certify that to the best of my knowledge and belief what is stated above is correct and truly stated.
Verified today the________________day of____________
Place__________
(Signature of the person giving the
certificate)
Name (in Block letters)
Address
Delete whichever is not applicable.