Form No. 60

Form of Declaration to be filed by a person who does not have either a Permanent Account Number or General Index Register Number and who makes payment in cash in respect of transactions specified in clauses (a) to (h) of rule 114B

1.    Full name and address of the declarant _____________________________
2.    Particulars of transaction: __________
3.    Amount of the transaction: __________
4.    Are you assessed to tax?      Yes/No
5.    If yes,
i.    Details of Ward/Circle/Range where the last return of Income was filed?
ii.    Reasons for not having Permanent Account Number/ General Index Register Number
6.    Details of the document being produced in support of address in Column(1) ______________________________________________________

Verification
I, __________________ do hereby declare that what is stated above is true to the best of my knowledge and belief.

Verified today, the _______________ day of ___________Year ________

Date: ___________
Place: __________

Signature of the Declarant

Instructions: Documents which can be produced in support of the address are:-
i.    Ration Card
ii.    Passport
iii.    Driving license
iv.    Identity Card issued by any institution
v.    Copy of the electricity bill or telephone bill showing residential address
vi.    Any document or communication issued by any authority or Central
vii.    Government, State Government or local bodies showing residential address
viii.    Any other documentary evidence in support of his address given on the declaration.