Rule - ANNEXURE- A

FORM OF STATEMENT FOR FURNISHING INFORMATION BY INFORMANT REGARDING BENAMI PROPERTY FOR REWARD AS PER BENAMI TRANSACTION INFORMANTS REWARD SCHEME, 2018

ANNEXURE- A

FORM OF STATEMENT FOR FURNISHING INFORMATION BY INFORMANT REGARDING BENAMI PROPERTY FOR REWARD AS PER BENAMI TRANSACTION INFORMANTS REWARD SCHEME, 2018

1.	Full name of the infoimant(s) (of each informant separately if there are more than one informant) (in capital letters)	:
2.	Father's name	:
3.	Date of Birth	:
4.	Permanent address of the informant(s)	:
5.	Current address of the Informants) (if different from permanent address)	:
6.	Contact particulars: (a) Landline Telephone No	:
(b)	Mobile No.	:
(c)	Email ID, if any	:
7.	Aadhar Number (foreign persons may mention Passport number if not having Aadhar number) (attach copy of Aadhar card or Passport) (of each informant separately if there are more than one informant)	:
8.	Full details of benami property: [The information furnished should be specific, reliable and verifiable. Additional sheet may be attached, if required (attach evidences, if any)]
(a)	Date of transaction	:
(b)	Total amount involved	:
(c)	Who paid the amount	:
(d)	How the amount was paid	:
(e)	To whom the amount was paid	:
(f)	Any other relevant information	:
9.	Name and address of beneficial owner (actual owner or beneficiary) of the benami property, if known (PAN may be mentioned, if known)	:
10.	Name and address of benamidar (name lender) of the benami property (PAN may be mentioned if known)	:
11.	Source of information:- (a) Whether the information has been acquired personally in the capacity of an employee, relation or partners etc., of the person mentioned at (9) and/or (10) above. (b) Whether information has been acquired through some other person, if so, his connection with the person at (9) and/or (10) above.
12.	List of documents, if any, furnished in support of the information	:
	(a) In original
	(b) Copy only	:
13.	Is any of the parties involved in the benami transaction related to you? If yes, furnish details.	:
14.	Briefly state:	:
(a)	How you have come to know about the information;	:
(b)	Special efforts, if any, made;	:
(c)	Risks and trouble undertaken	:
(d)	Expenditure, if any, incurred (attach evidence, if any, and attach extra sheet, if required)	:
15.	Informant Code, if any, allotted earlier	:
16.	Preferred mode of payment of reward (Cash/bank transfer) (in case of foreign persons reward will not be paid by cash)	:
17.	Bank Account particulars in which payment of reward is to be made (account no., bank name, branch, IFSC code, BIC or SWIFT code etc. details)	:
18.	In case of multiple informants, share at which reward is to be paid	:	Name of informant	Payable share (%)
18.		:

N.B. In case of multiple persons giving information about a single property, particulars of all such individual persons are required to be given in this pro forma.

DECLARATION

1.		I/we have read and understood the Benami Transactions Informants Reward Scheme, 2018, issued by the CBDT and agree with the terms and conditions contained in it
2.		I/we accept that mere furnishing of information by me/us does not by itself confer on me right to get reward and that I/we may not get any reward at all. I/we would be bound by the decisions that the authority competent to grant reward may take.
3.		I/we accept that reward would be an ex-gratia payment which, subject to the scheme, may be granted at the absolute discretion of the competent authority. The decision of the authority shall be final and I/we shall not challenge it in any litigation, appeal, adjudication or arbitration.
4.		I/we accept that the extent of the reward depends on the specific nature, precision and usefulness of the information furnished and assistance rendered by me.
5.		I/we accept that the reward process may take time and that interim reward is payable only after provisional attachment of benami property and final reward is payable only if the benami property has been confiscated under the Act and such confiscation has become final. The confiscation shall be deemed to be final if two years from the date of confiscation have passed and there is no litigation pending against such confiscation.
6.		I/we accept that the Government is under no obligation to enter into any correspondence regarding the action taken as a result of my information. I/We will be entitled to know only feedback and/or update about whether my/our information has been acted upon and, if yes, whether I/we am/are likely to get any reward.
7.		In the event of death of myself/any one of the informants before the reward is paid to me/us, it may be paid to my/our nominee(s) whose particulars (along with share) are as under:-

Name of informant	Name(s) and address(es) of the nominee(s)	Date of birth (in case of minor, name and address of guardian to be given)	Relationship with the informant	Share of the nominee(s)	Aadhar Care No./Passpor No. o nominee (attach copy)
(1)	(2)	(3)	(4)	(5)	(6)

I/We am/are aware that if the information furnished by me/us is found to be false I would be liable to prosecution as per law including under section 182 of the Indian Penal Code, 1860, and other relevant law.

Date:....................................	Signature of the informant:..................

Place:	Left Thumb impression:..................
	Aadhar card no./
	Passport No. (Attach copy):..................
Signature of the JCIT/Addl. CIT(BP)
before whom the statement is signed
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name & Designation of the Officer with Seal
Date: . . . . . . . . . . . . . . . . . . .
Place: . . . . . . . . . . . . . . . . . . .
Code No. allotted to the informant
Signature of the JCIT/Addl. CIT(BP) allotting Informant Code
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name & Designation of the Officer with Seal
Date: . . . . . . . . . . . . . . . . . . .
Place: . . . . . . . . . . . . . . . . . . .

Rule Number ANNEXURE- A

Footnotes