Printed from www.taxmann.com FORM NO. 34F [See rule 44G] Form of application for giving effect to the terms of any agreement under clause (h) of sub-section (2) of section 295 of the Income-tax Act, 1961 To The Competent Authority of India Foreign Tax and Tax Research, Department of Revenue, Ministry of Finance and Company Affairs, New Delhi Sir, Whereas the applicant is aggrieved by the action of the tax authority of _____________________________________________________ (name of the country) for the reasons given hereunder, the matter may kindly be taken up with the competent authority of ___________________________________ (name of the country) under Article _______________________________ of the ________________________________ (specify the agreement) between India and ____________________________________________ (name of the country). The relevant details in this regard are as under: Name of the Applicant in Block Letters Permanent Account No. Ward/Circle Office Address in Block Letters Telephone No. Assessment Year Residential Address in Block Letters Previous year(s) ending on [If applicable] Telephone No. Status Name and Designation of Tax Authority in the Foreign State (Treaty Partner) Date of the notice or order giving rise to the action Is the order/action of the income-tax authority of the country outside India not in accordance with the agreement? If so, the reasons thereof. (attach separate sheet if required) The following documents in support of our claim are enclosed: (1) Copy of notice or order giving rise to action (2) __________________________________________________________ (3) ___________________________________________________________ Verification I,_________________________________________ son/daughter/wife of Shri _____________________________________________ solemnly declare that to the best of my knowledge and belief, the information given in this application and the annexures and statements accompanying it is correct and complete and particulars shown therein are truly stated and relate to the previous year(s) relevant to the assessment year ___________________. 2. I also declare that to the best of my knowledge, I have not concealed any fact or information which could be relevant for deciding my application. Printed from www.taxmann.com 3. I further declare that I am making this application in my capacity as (designation) and that I am competent to make this application and verify it. Date ______________ Place ______________ (Signature)
