FORM NO. 63AA
[See sub-rule (2) of Rule 12BA]
Statement to be furnished in respect of income distributed by a securitisation trust

1. Name of the securitisation trust
2. Address of the principal place from where the
activities of the securitisation trust are being
carried out
3. Permanent Account Number
4. Previous year ending
5. Date of setting up of the securitisation trust
(DD/MM/YYYY)
6. Objects of the securitisation trust (Enclose a copy
of the trust deed)
7. Whether the securitisation trust is regulated by
(i) Securities and Exchange Board of India
(Public Offer and listing of Securitised Debt
Instruments) Regulations, 2008
Yes No
(ii) Reserve Bank of India guidelines on
securitisation of standard assets
Yes No
8. Whether the trustee(s)/securitisation trust is/are
registered with SEBI/RBI
Yes No
9. Name of Scheme(s)/series under which securitised
debt instruments/securities are issued
10. Income of the securitisation trust from the activity
of securitisation
Rs. ___________
11. Income distributed by the securitisation trust Rs. ___________
12. Details of income distributed, tax and interest payable
Income distributed Payment
towards tax
and interest
under section
115TB (Attach a
copy of
challans)
Amount
Sl.
No.
Date
of
distribution
Exempt
investors
Individuals/
HUFs
Any other
person
Total
Tax
payable
under
section
115TA
Interest
chargeable
under
section
115TB,
if
any Date of
payment
Amount
Enclose audited accounts including balance sheet, annual report, if any, with certified copies of income and appropriation towards distribution of income.
I, _____________________________________________________________ (Name in full and in block letters) son/daughter/wife of _______________________________________________ do hereby solemnly declare that to the best of my knowledge and belief what is stated above and in the Annexure(s), including the documents accompanying such Annexure(s), is correct and complete. I further declare that I am furnishing such statement in my capacity as_________________________________ (Designation) and that I am competent to furnish this statement and verify it.
Verified today the ________________ day of ________________
_________________ ___________________
Place Signature
Verification
I/We ________________________________________________ have examined the books of account and other documents showing the particulars of income earned and the income distributed to the investors by the ____________________________________ (name of the securitisation trust) for the previous year ending ________________________.
2. I/We declare that the above particulars are true and correct to the best of my/our knowledge and belief._________________ ________________________________
Place (Signature with name of the Accountant)
Date ____________
Notes:
1. Information in respect of investors whose income, irrespective of its nature and source, is exempt under the Act
2. Information in respect of investors whose income is not exempt
3. “Accountant” means the accountant as defined in the Explanation to sub-section (2) of section 288 of the Income-tax Act, 1961.