Annexure-B
FORM OF STATEMENT FOR FURNISHING INFORMATION REGARDING ASSESSEES / ASSETS FOR RECOVERY OF OUTSTANDING DEMAND
| 1 | FULL NAME OF INFORMANT | ||
| 2 | FATHER'S NAME | ||
| 3 | DATE OF BIRTH | ||
| 4 | ADDRESS OF INFORMANT, PAN/AADHAR NO. | ||
| 5 | TELEPHONE /MOBILE NUMBER | ||
| 6 | NAME & PAN OF THE ASSESSEE(S) IN RESPECT OF WHOM INFORMATION FURNISHED | ||
| 7 | NAME AND DESIGNATION OF OFFICER TO WHOM INFORMATION FURNISHED | ||
| 8 | DATE ON WHICH INFORMATION FURNISHED | ||
| 9 | LOCATION OF ASSESSEE AND/OR DETAILS OF ASSETS FROM WHICH RECOVERY OF DEMAND CAN BE MADE | ||
| 10 | PARTICULARS OF DOCUMENTS FURNISHED | In original | |
| Copy only | |||
| 11 | SOURCE OF INFORMATION/DOCUMENTS | ||
| (a) | Describe how you obtained the information/documents in respect of the assessee and describe your present or former relationship with the assessee | ||
| (b) | If information has been obtained through some other person, his connection with the person at 6. | ||
| ♦ | The information should be credible and supported by facts/documents and should not be Speculative or an educated guess. Attach all supporting information/documents and the availability and location of any additional supporting information/document not in your possession. Additional sheets may be attached it space is not sufficient. | |
| ♦ | Details should include bank, Branch and A/c No., Balance etc. of Bank deposits. In case of immovable assets, documents to prove ownership/ purchase/sale of property, court decree etc. |
DECLARATION
I declare that,
| (a) | I am aware that the information or document furnished by me do not ipso confer on me a right to any reward, and that I would be bound by any decision the authority competent to grant rewards may take. | |
| (b) | I am aware that the extent of the reward depends on the precision of the information and usefulness of the documents furnished by me, | |
| (c) | I am aware that the reward would pertain only to as much of the extra tax collected/realized as are directly attributable to the information supplied by me | |
| (d) | The provisions of section 182 of the Indian Penal Code have been read by me and explained to me and I am aware that if the information furnished by me is found to be false, I would be liable to prosecution. | |
| (e) | I accept that the Government is under no obligation to enter into correspondence regarding the details of taxes recovered as a result of my information. | |
| (f) | I accept that payment of reward is ex-gratia in the absolute discretion of the authority competent to grant reward and I have no right to dispute the correctness on the decision in any court of law. | |
| (g) | Subject to the provisions of para 3 (v) of the Guidelines, in the event of my death before the reward is paid to me, it may be paid to |
Signature of the Informant
Signature of the officer before whom the statement is signed.
Designation of the officer:
Date:
Place: