FORM NO. 10CCBC
(See rule 18DD)
Audit report under section 80-IA(11B)

1. Name of the assessee :
2. PAN :
3. Status :
4. Ownership of the hospital :
(a) Whether the hospital is owned by the assessee
Yes No
(b) (i) if no, name of the owner
(ii) whether the owner is a person referred to
in section 40A(2)(b)
Yes No
5. Name and address of the hospital :
6. Date of commencement of medical services :
7. Initial assessment year :
8. Approval from the local authority under the
local regulation (attach a copy of the approval
in the initial assessment year)
:
Approval Issuing authority Approval date and
number
(a) Permission for construction of the
hospital
(b) Completion certificate
9. Location of the hospital :
(i) Name of the locality/area in which the
hospital is situated.
(ii) Whether the said locality/area is within
the jurisdiction of a municipality or
Cantonment Board (please also indicate the
name of the municipality/Cantonment Board)
Yes No
(a) If yes, please indicate the population
size of the locality/area in which the
hospital is situated (as per 2001 census)
(b) If no, please indicate the distance of
h f th l l li it f th

such area from the local limits of the
municipality or Cantonment Board
10. Technical specifications of the hospital :
(a) Number of beds for the patients
(b) Whether an operation theatre is provided Yes No
(c) Whether a labour room is provided Yes No
(d) Whether a pathological laboratory is
maintained in the hospital
Yes No
(e) Number of qualified doctors available in
the hospital (Round the clock)
(f) Number of nurses available (Round the
clock)
(g) Whether hospital is equipped to handle
emergency cases
Yes No
(h) Whether the facilities in the nature of
Magnetic Resonance Imaging (MRI) /
Electrocardiogram (ECG) are available
Yes No
11. Details relating to computation of deduction :
(i) Total receipts from the business of
operating and maintaining a hospital in a rural
area
(ii) Other receipts of the undertaking
(iii) Transactions by the undertaking with a
related concern of the assessee, or another
undertaking of the assessee or the owner of
the undertaking
[Related concern is a person within the
meaning of section 40A(2)(b)]
Nature of the related persons/ concerns Transaction (Please specify Nature
and amount)
(a) Rs.
(b) Rs.
(c) Rs.
(d) Rs.
(iv) Profits derived from the business of
operating and maintaining a hospital in a rural area
(v) Deduction under section 80-IB(11B)
(amount in rupees)
Declaration
I/We have examined the balance sheet of the above undertaking
styled_______________and belonging to the assessee
M/s_________________________________(Permanent Account No_______________) as at______________________and the profit and loss account of the said undertaking for the year ended on that date which are in agreement with the books of account maintained at the head office at_________________and branches at_________________
I/We have obtained all the information and explanations which to the best of my/our knowledge and belief were necessary for the purposes of the audit. In my/our opinion, proper books of account have been kept by the head office and the branches of the undertaking aforesaid visited by me/us so far as appears from my/our examination of books, and proper returns adequate for the purposes of audit have been received from branches not visited by me/us, subject to the comments given below:—
In my/our opinion, the undertaking satisfies the conditions stipulated in section 80-IB and the amount of deduction claimed under this section is as per the provisions of the Income tax Act, and
In my/our opinion and to the best of my/our information and according to explanations given to me/us, the said accounts given a true and fair view—
(i) in the case of the balance sheet, of the state of affairs of the above named undertaking as at______________, and
(ii) in the case of the profit and loss account, of the profit or loss of the undertaking for the accounting year ending on_________________
Place___________
Date ___________ Signature Accountant$
Notes :
1. Delete whichever is not applicable.
2. Here give name and address.
3. Please provide profit and loss account and balance sheet of the undertaking.
4. $This report is to be given by—
(i) a chartered accountant within the meaning of the Chartered Accountants Act, 1949 (38 of 1949); or
(ii) any person who, in relation to any State, is, by virtue of the provisions in subsection
(2) of section 226 of the Companies Act, 1956 (1 of 1956), entitled to be
appointed to act as an auditor of companies registered in that State.