| VIJAYA BANK |
| Branch : |
| Form No.61 / See proviso to clause(a) of rule
114C |
| [Form of declaration to be filed by a person, who has
agriculture income and is not in receipt of any other income
chargeable to Income Tax in respect of transaction specified in
clause (a) to (h) of rule 114B] |
| |
| Sl.
No |
Particulars |
Information |
| 1. |
Full name &
address of the declarant |
|
| 2. |
Particulars of
transaction |
|
| 3. |
Amount of
transaction |
|
| 4. |
Details of the
document being produced in support of address in column
(1) |
| |
| |
I hereby
declare that my source of income is from agriculture and I am not
required to pay income tax on any other income, if
any.
SIGNATURE OF DECLARANT
Place:
Date:
|
| 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
____________ ,
SIGNATURE OF
DECLARANT
Place:
Date: |
| |
| Instructions |
| Documents, which can be produced in support of the address
are : |
| 1. |
Ration Card. |
| 2. |
Passport |
| 3. |
Driving
Licence. |
| 4. |
Identity
Card issued by any institution. |
| 5. |
Copy of
the Electricity Bill or Telephone Bill showing residential
address. |
| 6. |
Any
document or communication issued by any authority of Central
Government, State Government or Local Bodies showing
residential address. |
| 7. |
Any other
documentary evidence in support of his address in the
declaration. | |
| |