Printed from www.taxmann.com FORM NO. 10CCE [See rule 19AD] Certificate under sub-section (2) of section 80RRB for Patentees in receipt of royalty income, etc. PART A (To be filled in by the assessee) 1. Details of the patent: (i) Patent registration number (ii) Date of registration of patent (iii) Title of patent (iv) Whether the patent is in the native of patent of addition (Yes/No) (v) If reply to (iv) is yes, the title and registration number of original patent 2. Details of patentee: (i) Name and address of the patentee(s), (ii) Whether the patentee is the true and first inventor of the invention (Yes/No) (iii) Date on which the name of patentee was entered on the patent register (iv) Whether the name of the patentee was revoked or excluded from the patent register in respect of patent mentioned at item number (i) (Yes/No) (v) If reply to (i) is yes, the date from which such revocation or exclusion took place 3. Name, address of the person paying the royalty income from patent: 4. Details of royalty agreement: (a) The nature of royalty (mark !, where applicable) (i) transfer of all or any rights (including the granting of a licence) in respect of the patent (ii) imparting of any information concerning the working of, or the use of, the patent (iii) use of the patent (iv) rendering of any services in connection with the activities referred to in sub-clauses (i) to (iii) (v) consideration for sale of products manufactured with the use of patented process or the patented article for commercial use (b) Period for which the agreement is applicable (c) Amount of royalty income payable for the previous year (in Indian rupees) 5. Details of payments: (i) Payment received in Indian rupees (ii) Payment received in foreign currency (value in Indian rupees) (iii) Total payment received Printed from www.taxmann.com (iv) If in foreign currency, details of payment in the following proforma : Total amount payable during the year Amount actually paid Date of payment Mode of payment 6. Verification : This is to verify that I/we,_______________________________s/o__________________________having PAN No_______________________________is/are the patentee, being true and first inventor of the invention, in respect of the patent titled___________________entered in the patent register maintained by the patent office at________________under the Patents Act, 1970. This is to further verify that during the previous year, I/we have received payment in the nature of royalty income from such patent from Shri/Smt./Ms.____________________________which is entitled for deduction under section 80RRB of the Income-tax Act, 1961. Signature and name of the assessee Date : ___________ __ Place : ___________ Address: PART B (To be filled in by the prescribed authority) Certification This is to certify that the information furnished by the assessee named________________________________________in items Number and 1 and 2 of Part A is correct as per the patent register maintained by us. This is to further certify that a compulsory license has/has not (strike off whichever is not applicable) been issued by the Controller in respect of the patent mentioned at item number 1 of Part A, and the royalty income settled in terms of any compulsory license, pertaining to the period starting from 1st April,_________and ending at 31st March,__________is rupees_______________________________(not to be filled in if no compulsory license is issued). Name, designation and signature of the Controller Date : __________ Place : __________ Address:
