[See Sagar] Form for furnishing accountant certificate under section 398(2) for person responsible for collection of tax as per section 394(1)[Table: Sl. No. 1 to 5 and 9] not to be deemed to be an assessee in default Part A

Particulars of the seller
1.Name(refer Note 1)
2.Address(refer Note 2)
3.Permanent Account Number(refer Note 3)
4.Tax Deduction and Collection Account
Number, if applicable
Particulars of the person responsible for collecting tax
5.Name(refer Note 1)
6.Address(refer Note 2)
7.Permanent Account Number
Particulars of the buyer
8.Name(refer Note 1)
9.Address(refer Note 2)
10.Permanent Account Number
Particulars of transactions
11.Amount received from/debited to the
account of the buyer after––
(a) non-collection of tax
(b) short-collection of tax
(c) Total (a)+(b)
12.Amount of interest under section
398(3)(a) on amount referred to in 11(c)
above
13.Whether the interest referred to in Sl.
No. 12 above, has been paid
Yes/No
14.If answer to Sl. No. 13 above is yes,
please provide details of such payment
Challan Details BSR Code of the bank Challan Serial Number Date of deposit through challan or Book Identification Number (refer Note 4) Receipt Number (first seven Receipt Number (first seven Date of deposit through digits of BIN) digits of BIN) challan
Challan Details
BSR Code of the bankChallan Serial NumberDate of deposit through
challan
Book Identification Number (refer Note 4)
Receipt Number (first seven
digits of BIN)
Receipt Number (first seven
digits of BIN)
Date of deposit through
challan

DECLARATION I….. (name of the person responsible for the collection of tax) having permanent account number …. in the case of ….. (name of the seller) declare and state that above details are true and correct.
Further, a certificate from an accountant certifying that the payee has fulfilled all the conditions mentioned in section 398(2) is enclosed as Annexure A to this Form.
Place: ………… Signature of the person responsible for
collection of tax

Date: ………… Name:

                             Designation: 

                 

Notes:

  1. 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.

  2. The address shall contain i. Country/Region, ii. Flat/Door/Block number iii. Road/Street/Block/Sector, iv. PIN/ZIP Code, v. Post Office, vi. Area/locality, vii. District, viii. State.

  3. In case of Government collectors, for ―Permanent Account Number‖, shall be mentioned as ―PANNOTREQD‖.

  4. For payment made without production of challan by the Government collector.

  5. Some of the information in the form would be pre-filled to the extent possible.

  6. Amounts to be filled in ₹ unless otherwise provided.

ANNEXURE A Certificate of accountant under section 398(2) for certifying the furnishing of return of income, payment of tax etc. by the buyer/licensee/lessee. I hereby confirm that I have examined the relevant accounts, documents and records of… (name and address of the buyer/licensee/lessee) with [Permanent Account Number] ….. for the period … and hereby certify the following:
i) ….. (seller/licensor/lessor) has received from or debited following sum to the account of ….. (buy- er/licensee/lessee) without collection of whole or any part of the tax in accordance with the provi- sions of Chapter XIX of the Act

NatureDate ofSl. No. of sectionAmountAmount ofDetails of amount
ofreceipt or394 under whichreceived ortaxcollected, if any
receiptdebittax was collectibledebitedcollectible
AmountDate of
collectedcollection

ii) The buyer or licensee or lessee, has furnished his return of income for the tax year……………… relevant to the receipt referred to in (i) above. The details of return of income filed by the buyer/licensee/lessee are as under—

Date of filing ofAcknowledgementAmount of taxableTax due on theDetails
return ofnumber of return filedincome as per returnincome declared inof tax
incomefiledreturnpaid

iii) The payee or buyer or licensee or lessee has taken into account the sum referred to in (i) for computing his taxable income in return of income filed by him, the details of which are as under:

Payment onHead of incomeGross payment under theAmount of taxable income
which tax hasunder whichhead of income under whichunder the head of income
not beenpayment isthe payment is accounted forunder which the payment is
collectedaccounted foraccounted for

iv) It has been ensured that the information furnished is true and correct in all respects and no relevant in- formation has been concealed or withheld. v) Neither I, nor any of my partners, is a director, partner or an employee of the above-mentioned entities or its associated concerns. Verification I ………………. having Permanent Account Number ………… fully understand that any statement made in this certificate, if proved incorrect or false, will render me liable for any penal or other consequences as may be prescribed in law or is otherwise warranted. Place Signature Date

Name of the Accountant…………………………… Designation…………………………… Membership Number…………………. UDIN Details, if any…………………. Name of the proprietorship/ firm………………….. Firm Registration Number………………………..

Notes: *Delete whichever is not applicable

This certificate is to be given by––

(i) a chartered accountant within the meaning of the Chartered Accountants Act, 1949 (38 of 1949); or (ii) any person, who in relation to any State, is by virtue of the provisions in Chapter X of the Companies Act, 2013 (18 of 2013) entitled to be appointed to act as an auditor of companies registered in the State.