FORM NO. 10CCE
[See rule 19AD]
Certificate under sub-section (2) of section 80RRB
for Patentees in receipt of royalty income, etc.
PART A
(To be filled in by the assessee)
1. Details of the patent:
(i) Patent registration number
(ii) Date of registration of patent
(iii) Title of patent
(iv) Whether the patent is in the native of patent of
addition (Yes/No)
(v) If reply to (iv) is yes, the title and registration number
of original patent
2. Details of patentee:
(i) Name and address of the patentee(s),
(ii) Whether the patentee is the true and first inventor of
the invention (Yes/No)
(iii) Date on which the name of patentee was entered on
the patent register
(iv) Whether the name of the patentee was revoked or
excluded from the patent register in respect of patent
mentioned at item number (i) (Yes/No)
(v) If reply to (i) is yes, the date from which such
revocation or exclusion took place
3. Name, address of the person paying the royalty
income from patent:
4. Details of royalty agreement:
(a) The nature of royalty (mark !, where applicable)
(i) transfer of all or any rights (including the granting
of a licence) in respect of the patent
(ii) imparting of any information concerning the
working of, or the use of, the patent
(iii) use of the patent
(iv) rendering of any services in connection with the
activities referred to in sub-clauses (i) to (iii)
(v) consideration for sale of products manufactured
with the use of patented process or the patented
article for commercial use
(b) Period for which the agreement is applicable
(c) Amount of royalty income payable for the previous
year (in Indian rupees)
5. Details of payments:
(i) Payment received in Indian rupees
(ii) Payment received in foreign currency (value in
Indian rupees)
(iii) Total payment received
(iv) If in foreign currency, details of payment in the
following proforma :—
Total amount payable
during the year
Amount actually paid Date of payment Mode of payment
6. Verification :
This is to verify that
I/we,_______________________________s/o__________________________having PAN No_______________________________is/are the patentee, being true and first inventor of the invention, in respect of the patent titled___________________entered in the patent register maintained by the patent office at________________under the Patents Act, 1970. This is to further verify that during the previous year, I/we have received payment in the nature of royalty income from such patent from Shri/Smt./Ms.____________________________which is entitled for deduction under section 80RRB of the Income-tax Act, 1961.
Signature and name of the assessee
Date : ___________
__
Place : ___________ Address:
PART B
(To be filled in by the prescribed authority)
Certification
This is to certify that the information furnished by the assessee
named________________________________________in items Number and 1 and 2 of Part A is correct as per the patent register maintained by us.
This is to further certify that a compulsory license has/has not (strike off whichever is not applicable) been issued by the Controller in respect of the patent mentioned at item number 1 of Part A, and the royalty income settled in terms of any compulsory license, pertaining to the period starting from 1st April,_________and ending at 31st March,__________is rupees_______________________________(not to be filled in if
no compulsory license is issued).
Name, designation and signature of the Controller
Date : __________
Place : __________ Address: