FORM NO. 10G

[See rule 11AA]

Application for grant of approval or continuance thereof to institution or

fund under  section 80G(5)(vi) of the Income-tax Act, 1961

1. Name of the institution/fund in full (in block letters)

2. Address of the registered office of the institution/ fund

3. Legal status [please specify whether the institution/ fund

is-

(i) constituted as public charitable trust;

(ii) registered under the Societies Registration Act,  1860

(21 of 1860) or under any law corresponding to that

Act in force in any part of India;

(iii) registered under section 25 of the Companies Act, 1956

(1 of 1956);

(iv) a University established by law;

(v) any other educational institution recognised by the Gov-

ernment or by any University established by law or af-

filiated to any University established by law;

(vi) an institution wholly or partly financed by the Govern-

ment or a local authority;

(vii) an institution established with the object of controlling,

supervising, regulating or encouraging games or sports

and is approved for this purpose under section 10(23);

or

(viii) A Regimental Fund or Non-Public Fund established by

armed forces of the Union for the welfare of past or

present members of such forces or their dependants.]

4. Objects of the institution/fund and geographical area over

which its activities are undertaken

5. Names and addresses of trustees/office bearers of the insti-

tution or fund

6. (i) If registered under section 12A(a) of the Income-tax

Act, the registration number and date of registration

(ii) If notified under section 10(23) or under section

10(23C)of the Income-tax Act, the details thereof

(iii) If responses to (i) & (ii) are negative, whether any ap-

plication for the same has been filed? If yes, enclose a

copy of the same.

7. (a) Period of last approval, if any. Please enclose a copy of

the approval

(b) If any change in the aims and objects and the rules and

regulations have been made since the last approval, the

details thereof

8. Assessment particulars-

(a) Ward/Circle where assessed and permanent account

number/GIR number

(b) Is the income exempt under section 10(22), 10(22A),

10(23), 10(23AA), 10(23C) or 11?

(c) Whether any arrears of taxes are outstanding? If so,

give reasons

9. Amount accumulated for the purposes mentioned in item

(4) above

(i) Details of modes in which the funds are invested or

deposited, showing the nature, value and income from

the investment;

(ii) Whether any funds have not been invested in the modes

specified in section 11(5)?

11. (i) Is the institution/fund carrying on any business? If yes,

give details

(ii) Is the business incidental to the attainment of its ob-

jects?

12. Details of nature, quantity and value of contributions (other

than cash) and the manner in which such contributions have

been utilised.

13. Details of shares, security or other property purchased by

or on behalf of the trust from any interested person as speci-

fied in sub-section (3) of section 13.

14. Whether any part of the income or any property of the as-

sociation was used or applied in a manner which results

directly or indirectly in conferring any benefit, amenity or

perquisite (whether converted into money or not), on any

interested person as specified in sub-section (3) of section

13? If so, details thereof.

I certify that information furnished above is true to the best of my knowledge and belief.

I undertake to communicate forthwith any alteration in the terms or in the rules governing the institu-

tion/fund made at any time hereafter.

Place……………………

 …………………………….……………..

Date ………….………..

 Signature

……………………………………………..

Designation

………………………………………

………………………………………

Address

Notes : The application form (in triplicate) should be sent to the Commissioner of Income-tax having

jurisdiction over the institution or fund along with the following documents:

(i) Copy of registration granted under section 12A or copy of notification issued under section10(23)

or section 10(23C).

(ii) Notes on activities of institution or fund since its inception or during the last three years, whichever

is less.

(iii) Copies of accounts of the institution or fund since its inception or during the last three years, which-

ever is less.