FORM NO. 63
[See rule 12B]
Statement to be furnished to the Assessing Officer designated under rule 12B of the Income-tax Rules, 1962, in respect of income distributed by the Unit Trust of India
(Separate forms to be filled up for each scheme)
1. Address of Registered Office
2. Permanent Account Number
3. Previous Year ending
4. Name and address of the office bearers
5. Name of Scheme
6. Face Value of Unit
7. Total No. of Units
8. Details of income distributed :—
Distribution or Payment of
Income
Tax payable under
section 115R
Interest chargeable
under section 115S, if
any
Payment towards tax and interest
under section 115S (Attach a copy of
challans)
Date(s) Amount(s) Date(s) Amount(s)
9. Tax payable on income distributed to the Unit holders.
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 unit holders by the Unit Trust of India 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 : _____________
Note 1. “Accountant” means the accountant as defined in the Explanation to sub-section (2) of section 288 of the Income-tax Act, 1961.