Printed from www.taxmann.com 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 of 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 Printed from www.taxmann.com ________________________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.
