FORM NO. 128 [See Rule 213 - Application for grant of certificates for deduction or collection of income-tax at any lower rates, …] Application for issuance of certificate for lower or nil deduction of income-tax under Section 395 - Certificates section 395(1) and lower collection of income-tax under Section 395 - Certificates section 395(3)
(To be filed electronically by Person seeking certificate for no deduction of tax or deduction or collection of tax at a lower rate)
| PART - A | ||||||
| Tax Year | 20_ _ – 20 _ _ | |||||
| 1. | Details of Applicant | |||||
| (a) | Name | (refer Note 1) | ||||
| (b) | Address | (refer Note 2) | ||||
| (c) | Status | (refer Note 3) | ||||
| (d) | Permanent Account Number | |||||
| (e) | Residential Status | (refer Note 4) | ||||
| (f) | E-mail id | |||||
| (g) | Contact Number | Country Code | Number | |||
| PART – B | ||||||
| 2. Application filed by: (Radio Button) | o Registered non-profit organization o Specified Entity referred to in section 263(9)(c) o Person carrying on business or profession o Persons other than the above | |||||
| 3. | Details of Request | |||||
| I do hereby request that a certificate may be issued to: (tick as applicable) the person responsible for paying income/sum to me with deduction of income-tax at a lower rate or without de- duction of income-tax. The details of these are mentioned in Annexure I. me since I do not have the details of the payer, to receive income/sum with deduction of income-tax at a lower rate. The relevant information is included in Annexure II. the person responsible for paying income/sum to me for receiving the income/sum with deduction of income-tax at a lower rate or without deduction of income-tax. The details are specified in Annexure- I. [Applicable for Regis- tered non-profit organization and Specified Entity referred to in section 263(9)(c)] to me for receiving the income/sum with deduction of income-tax at a lower rate. The details are specified in An- nexure- II. [Applicable for Registered non-profit organization and Specified Entity referred to in section 263(9)(c)] the Seller/Lessor/Licensor to collect income tax at a lower rate at the time of debit of such amount to my account or receipt thereof from me. The specific details are provided in Annexure III. | ||||||
| PART – C | |||||||||||||
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| 4. | Details of existing tax liabilities (as on date of filing of application) | ||||||||||||
| Sl. No. | Liability under the Act | Tax Year | Amount (Advance tax/ Self- Assessment tax) | Amount payable but not paid, for which notice of demand under section 289 or under section 156 of the Income-tax Act, 1961(43 of 1961) (as it existed prior to its repeal), as the case may be, has been served | Amount payable but not paid in capacity of deductor or collector which has become due | Total liability | Remarks, if any | ||||||
| (A) | (B) | (C) | (A) + (B) + (C) | ||||||||||
| 1. | Income-tax Act, 2025 (30 of 2025) | ||||||||||||
| 2. | Income-tax Act, 1961 (43 of 1961) (as it existed prior to its repeal) | ||||||||||||
| 5. | Particulars of income and other relevant details (for the relevant tax year) | ||||||||||||
| (a) | Estimated total income (Attach computation) | ||||||||||||
| (b) | Tax including interest payable on the Total income [referred to in 5(a)] | ||||||||||||
| (c) | Income claimed to be exempt and not included in the Total income in 5(a). (Attach note giving reason for claiming such exemption) | ||||||||||||
| (d) | Prepaid taxes (as per AIS): | (i) Advance Tax | |||||||||||
| (ii) Tax deducted at source | |||||||||||||
| (iii) Tax collected at source | |||||||||||||
| (e) | Details of return of income for four tax years preceding to the tax year: | ||||||||||||
| Tax Year | Acknowledgement Number | Date of filing of return of income | Taxable Income | Tax Liability | |||||||||
| (i) | |||||||||||||
| (ii) | |||||||||||||
| (iii) | |||||||||||||
| (iv) |
| * In case return is not filed for any of the preceding four tax years, attach computation of income for such year. |
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PART – D
Applicable in case of Registered Non-Profit Organisation or Specified entity referred to in Rule 213 - Application for grant of certificates for deduction or collection of income-tax at any lower rates, …
| Declaration | |
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| I ………………. having Permanent Account Number ……………. do hereby declare that: the applicant is registered vide certificate/registration number ………………………. the applicant has furnished the returns of income for last four tax years for which such returns became due on or before the date on which the application under sub-rule (1) of Rule 213 - Application for grant of certificates for deduction or collection of income-tax at any lower rates, … is made. the applicant being a specified entity referred in Rule 213 - Application for grant of certificates for deduction or collection of income-tax at any lower rates, … is approved for the purpose of exemption from Income- tax. the incomes/sum referred to in this form are not includible in the total income of any other person under sections 96 to 99. Place: ………… Signature Date: ………… Name: | |
| PART – E Applicable in case of Person other than person mentioned in Part-D |
| the applicant has furnished the returns of income for last four tax years for which such returns became due on or |
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| before the date on which the application under sub-rule (1) of |
| Declaration |
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| I ……………… having Permanent Account Number ……………….. do hereby declare that: the applicant has furnished the returns of income for last four tax years for which such returns became due on or before the date on which the application under sub-rule (1) of Rule 213 - Application for grant of certificates for deduction or collection of income-tax at any lower rates, … is made. the incomes/sum referred to in this form are not includible in the total income of any other person under sections 96 to 99. Place: ………… Signature Date: ………… Name: |
| the applicant has furnished the returns of income for last four tax years for which such returns became due on or |
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| before the date on which the application under sub-rule (1) of |
| PART – F | ||||||||
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| Verification | ||||||||
| I, _____________ (full name), having PAN _____________ in the capacity of _____________ (designation) solemnly declare that the information given above is true to the best of my knowledge and belief and no relevant information has been concealed. | ||||||||
| Signature | ||||||||
| Date | ||||||||
| Address | ||||||||
| ANNEXURE - I | ||||||||
| [Relevant for tax deduction at source] Please furnish following particulars in respect of the incomes/sum for which the certificate is sought | ||||||||
| Sl. No. | Section under which tax at source is liable for deduction | Table Sl. No. under which tax at source is liable for deduction | TAN/PAN of the Payer | Estimated amount of income/sum to be received during the tax year | Requested Rate of Deduction (refer Note 5) | |||
| (1) | (2) | (3) | (4) | (5) | (6) | |||
| ANNEXURE - II | ||||||||
| [Relevant for tax deduction at source] Please furnish following particulars in respect of the incomes/sum for which the certificate is sought (Please upload a note justifying the issue of certificate under sub-rule 9 of Rule 213 - Application for grant of certificates for deduction or collection of income-tax at any lower rates, …) | ||||||||
| Sl. No. | Section under which tax at source is liable for deduction | Table Sl. No. under which tax at source is liable for deduction | Estimated amount of income/sum to be received during the tax year | Requested Rate of Deduction (refer Note 5) | ||||
| (1) | (2) | (3) | (4) | (5) | ||||
| ANNEXURE -III | ||||||||
| [Relevant for tax collection at source]; Please furnish following particulars in respect of amount receivable for which the certificate is sought | ||||||||
| Sl. No. | Section under which tax at source is liable | Table Sl. No. under which tax at source is liable for | TAN of the Seller/ Lessor/ | Estimated amount to be | Requested Rate of Collection |
| for collection | collection | Licensor | debited/paid during the tax year | ||
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| (1) | (2) | (3) | (4) | (5) | (6) |
Date…… Signature………….
Place…..
Notes:
- In case of individual, the first, middle and last name shall be provided in full without any abbreviations. In any other case also, name shall be provided in full.
- The address shall contain i. Country/Region, ii. Flat/Door/Building, iii. Road/Street/Block/Sector, iv. PIN/ZIP Code, v. Post Office, vi. Area/locality, vii. District, viii. State.
- Fill ‗person‘ status as (i) Individual (ii) Hindu undivided family (iii) Company (iv) Firm (v) Association of per- sons, whether incorporated or not (vi) Body of individuals, whether incorporated or not (vii) Local Authority (viii) Artificial Juridical Person (ix) Government (x) Trust
- Fill ‗residential status‘ as (i) Resident (ii) Non-resident (iii) Resident but not ordinarily resident.
- Fill ‗0‘ where requested rate of deduction is Nil.
- Some of the information in the form would be pre-filled to the extent possible.
- Amounts to be filled in ₹ unless otherwise provided.