FORM NO.10HA
[ See rule 29AA]
Form of certificate under second proviso to section 80-O of the Income -tax Act, 1961
PART A
CERTIFICATE OF FOREIGN INWARD REMITTANCE TO BE GIVEN BY BANK
Bank …………..…………………………………………………………
No. ……………………………….
Ref. No. …………………………..
Date ……………………………….
1. We certify that we have received the following remittance and proceeds thereof were paid :
(a)
to beneficiary M/s …………………………………………………………………………………………….…………
(Name and address) on ……………………………..…………………………………………………………………..
By
Cash …………………………………………………………………….
By Pay-Order
…………………………………………………………………….
By Credit to Current/Saving/ Cash Credit Account with us/ with our ……………………………………………….…
office for beneficiary's account, or
to …..…………………………………. Bank ……………………………………………… on ……………..
for credit of beneficiary of M/s……………………………………………………..'s Account
(b)
2. Name and address of remitter ……………………………………………………………………………………………
3. Name and address of remitting bank …………………………………………………………………………………
Demand Draft/ Telegraphic Transfer/ Money Transfer No. ……………………..dated …………………… foreign
currency amount ……..………….. Rupee equivalent
………………………………………………………………………………………………………………………………………..
(Rupees
………………………………………………………………………………………………………………………………………..)
Favouring
………………………………………………………………………………………………………………………………………..
4.
5. Exchange rate applied
………………………………………………………………………………………………………………………………………..
6. Purpose of remittance as stated by remitter / beneficiary
……………………………………………………………………………
We also certify that the payment thereof has/ has not been received in non -convertible rupees or under any
special trade or payments agreement.
We confirm that we have obtained reimbursement in any manner approved by the Reserve Bank of India and
according to the laws.
For ………………………………….………………. Bank
To
…………..…………………………
……………………..………………
…………………………………….
Manager
_________________________
(name and designation)
_____________________________________________
____________________________
(Address)
PART – B
CERTIFICATE TO BE GIVEN BY ELIGIBLE ASSESSEE
1.
Inward remittance received during the previous year
…………………………..
(i)
Whether the convertible foreign exchange in (i) was brought into India within
a period of six months from the end of the previous year.
2.
Yes/No
(ii)
If not, whether it was brought into India within such further period in the
previous year as allowed by the Competent Authority
Yes/No
(iii) Specify the amount and the relevant previous year in case such amount is
brought into India in convertible foreign exchange beyond the period of six
months from the end of relevant previous year and with the approval of the
competent authority, where such amount relates to any other previous year.
(Specify the authority and the period upto which the approval has been
accorded).
……………………………….
………………………………
……………………………….
I certify that the total deduction of Rs. ………….………………. claimed under section 80-O in respect of assessment year
…….……………. is correctly claimed in accordance with the provisions of the section.
I hereby certify that the above particulars contained in Part A and Part B of this certificate are true and correct to the
best of my knowledge and belief and nothing has been concealed therein.
……………………………………
(Signature)
Place ……………………………..
Date ……………………………..