FORM NO. 30C

[See rule 43]

Form for furnishing the details under section 230(1A) of the Income-tax Act, 1961

To

__________________

[Designation of the Prescribed Authority]

Sir,

 I give below the necessary particulars as required under sub-section (1A) of

section 230:

1. Full Name (in Block letters) :

2. Present Address

 :

3. Permanent Address

 :

4. Name of *father/husband

 :

5. Nature of business/profession in India :

6. *The PAN allotted under section 139A

Or

*My total income is not chargeable to

income-tax (certificates as per annexure)

Or

*I am not required to obtain a PAN under

the Income-tax Act, 1961 (certificate as per

annexure)

7. The purpose of visit outside India :

8. Estimated period of stay outside India :

9. Passport No./Emergency Certificate No. ….

(a)   Issued on (date) …………………..

(b)   From (Place) ……………..

I declare that to the best my knowledge and belief, the information furnished is

correct and truly stated.

Place :  _________

 Yours faithfully

Date :    _________

 Applicant

*Delete whichever is not applicable.

ANNEXURE

Certificate to be furnished by a person domiciled in India whose total income is

not chargeable to income-tax or who is not required to obtain a PAN under the

Income-tax Act

I __________ *son/daughter/wife of _______________ resident of ______ do

hereby certify that:

(a) *No permanent account number has been allotted to me under the

provisions of section 139A of the Income-tax Act, 1961;

OR

(b) *My total income computed in accordance with the provisions of the

Income-tax Act, 1961 is not chargeable to tax;

OR

(c) *I am not required to obtain a permanent account number under the

provisions of Income-tax Act, 1961

 ………………………………………..

(Signature of the person giving the certificate)

Name (in Block letters)_________________

            Address ____________________________

VERIFICATION

I _____________ do hereby certify that to the best of my knowledge and belief

what is stated above is correct and truly stated.

Verified today the _______ day of ________________

Place:

 ………….…………………………..

(Signature of the person giving the certificate)

           Name (in Block letters) _________________

           Address ____________________________

*Delete whichever is not applicable.”;