FORM NO.

I5H
[Sec section 197A(1C) and rule 29C]

Derlnretion under sermon 197A(IC) to be mede by on indiiJdual who is of the age of sixty years or more
claiming certain incomes without deduction of tax.
PART I
1. Name of Assesses (Dcclarant) 2. PAN of the Assesses‘ 3. Date of Birth‘
MARREDDY SAI JASWANTH REDDY HIJPS2461D 26/08/1996

4. Previous year(P.Y.)’ 2024-2025 5. FlatDoor,Block 6 - 5 4 - 1 6. Name of Premises

Ananthapur
7. Roañ''Strcet1ane 8. Area x›cality 9. Town‘City District 10. State
Kalyanduram road Nandhamuri nagar Ananthapur Andhra Pradesh
PIN 12. Emil t3. Telephone No. (with STD Code) and Mobile No.
515004 939823020
14 (a) Whether assessed to tax’: No

(b) If yes. latest assessment which asset

15. Estimated income for w'hich this declaration is 16. Estimated total income of the P.Y. in xvhich incoirie
Niadc 1503 mentioned in colimui 15 to be included’

17. Dctails of Forni No.15H othcr than this forni filcd for the pwious year. if any°
Total No. of Forni No.15H filcd Aggregate amount of incouic for which Forni No.15H
filed
0 0
18. Details of income for r4 ich the declaration is filed
SI. Identification nimbcr of Nature of income Section under which Amount of income
No. relevant inxesb cut/account. tax is deductible

0 0 194A 0

Signature of the Dcclarant

I...MARREDDYSAIJASWANTHREDDY...................do hereby declare that I am rcsi‹lcnt in India *ithin

the waning of section 6 of the Income-tax Act. 1961. I also hereby declare that to the best of icy knowledge
and belief what is stated above is correct. coipplete and is truly stated and that the incomes referred to in this
form are not includiblc in the total income of any other person under sections 60 to 64 of the Income-tax Act.
1961. I further declare thnt the tax on my estimated toal income including *incoiuc/'inconics referred to in
eolimin 15 *and aggregate amount of
*incoine'incooics referred to in colunm 17 computed in accordance with the proxfiions of the Income-tax Act,
1961. for the previous year ending on ..........2024.......... relevant to the assessment ycnr2025wN be nil.

Place:......................ANANTHAPUR........
..........................
saijaswanthreddy
Signature of the Dcclarant
Datc:.....................02/02/2025..............................
.....
 [To be Bllcd by the person responsible for paying the income referred to in column 15 of Part I]

1. Name of the person respmsible for payiog 2. Unique Idcntifîcaäon No.’

3. PAN of the person responsible for 4. Complete Address 5. TAN of the person responsible for

6. Email 7. Te1eph‹mc No. (wi& STD Code) and Mobile 8. Amoimt of income paid“
No.

9. Date on which Declaration is received 10. Date on which the income has been paid/credited
(DD/MM/YYYY) (DD/MM/YYYY)

Signature of the person responsible for paying

the income rcfcned to in column 15 of Part I
*Delete whichever is not applicable.
l
As per provisions of section 206AA(2), the declaration imdcr section 197A(1C) shall be invalid if the
dcclarant fails to furnish his valid Permanent Accoimt Number (PAN).
laration can be furnished by a resident individual who is of &e age of 6o years or more at any time during the

Mick year to which the income potains.

’ Please mention “Yes” if assessed to tax under the provisions of Income-tax Act. 1961 for any of the assessumit
of six assessment years prccodipg the year in which the declaration is filed.
mention the auxnmt of estimated total income of the previous year for which the doclamtion is filed
including the amount of income for which this dcclaration is made.

W case any declaration(s) in Form No. 15H is filed before filing this declaration during the previous
year, mention the total nuœber of such Form No. 15H filed along with the aggregate amount of income
for which said declaration(s) have been filed.
Mention the distinctive number of shares, account number of term deposit, recurring deposit. National
Savings Schèmes, life insurance policy number, employer code. etc.
before signing the declarationfverification, the declarant should satisfy himself that the information
fumished in this form is true, correct and complete in all respects. Any person making a false stateinent
in the declaration shall be liable to prosecution under section 277 of the Income-tax Act, 1961 and on
conviction be punishable-
(i) in a case where tax sought to be evaded exceeds twenty-five lakh rupees, with rigorous
imprisonment which shall not be less than six months but which may extend to seven years and
with fine:
(ü) in any other case, with rigorous imprisonment which shall not be less than three months but
which may extend to two years and with fine.
de person responsible for paying the income referred to in column 15 of Part I shall allot a unique
identification number to all the Form No. 15H received by him during a quarter of the financial year and
report this reference number along with the particulars prescribed in rule 31A(4)(vü) of the Income-tax
Rules, 1962 in the TDS statement fumished for the same quarter. In case the person has also received
Form No.15G during the same quarter, please allot separate series of serial niimber for Form No.15H
and Force No.15G.
“The person responsible for paying the income referred to in column 15 of Part I shall not accept the
declaration where the amount of income of the nature referred to in section 197A(IC) or the aggregate of
the amounts of such income credited or paid or likely to be credited or paid during the previous year in
which such income is to be included exceeds the maximum amount which is not chargeable to tax after
allowing for deduction(s) under Chaptes VI-A, if any. or set off of loss, if any, under the head “income
from house property” for which the declannt is eligible. For deciding the eligibility, he is required to
verifÿ income or the aggregate amount of incomes, as the case may be, reported by the declarant in
columns 15 and 17.".