[ I T R 6 2 ; 6 1 A , 2 ] Printed From Taxmann's Income Tax Rules 2001 FORM No. 61A [See rule 114E] Annual Information Return under section 285BA of the Income -tax Act, 1961 (PART-A) n Please see the instructions and fill up relevant columns 1. Name of the person (in block letters) (Please leave one blank box between two words.) 2. Permanent Account Number (PAN) of the person (see instructions) 3. Folio Number of the person (see instructions) 4. Address (in block letters) (Please leave one blank box between two words.) 4.1 Flat No. 4.2 House/Premises No. 4.3 Floor No. 4.4 Building Name 4.5 Block/Sector 4.6 Road/Street 4.7 Locality/Colony 4.8 City 4.9 State Code (Refer to State Code in instructions) 4.10 Pin Code 5. Status (Individual-I, Company-C, Firm-F, Hindu undivided family-H, Government Office-G, Banks-B, Others-O) 6. Financial Year (transactions relating to which are reported) - 7. Address of Jurisdictional Director of Income-tax (Central Information Branch) 8. Total number of transactions reported in Annual Information Return (Part B) 9. Total value of all transactions reported in Annual Information Return (Part B) Rs. 10. Medium of Annual Information Return (Please strike off inapplicable)-CD/Floppy/DVD/ONLINE Verification I, (full name in block letters), son/daughter of solemnly declare that to the best of my knowledge and belief, the information given in Part A and Part B of this return is correct and complete. I further declare that I am making this return in my capacity as and I am also competent to make this return and verify it. I further [ I T R 6 2 ; 6 1 A , 2 ] Printed From Taxmann's Income Tax Rules 2001 certify that the floppy/CD-ROM/Digital Video Disc/online data through which Part-B is submitted is clean and virus free. Date Signature Place Name (FOR OFFICE USE) Receipt No. : Date : Name & Signature of person receiving : Annual Information Return (with Stamp) (PART- B) 1. Name of the person (in block letters) (Please leave one blank box between two words.) 2. Permanent Account Number (PAN) of the person (see instructions) 3. Folio Number of the person (see instructions) 4. Address (in block letters) (Please leave one blank box between two words.) 4.1 Flat No. 4.2 House/Premises No. 4.3 Floor No. 4.4 Building Name 4.5 Block/Sector 4.6 Road/Street 4.7 Locality/Colony 4.8 City 4.9 State Code (Refer to State Code in instructions) 4.10 Pin Code 5. Status (Individual-I, Company-C, Firm-F, Hindu undivided family-H, Government Office-G, Banks-B, Others-O) 6. Financial Year (transactions relating to which are reported) - 7 Total number of transactions reported in Annual Information Return 8 Total value of all transactions reported in Annual Information Return (in Rupees) [ I T R 6 2 ; 6 1 A , 2 ] Printed From Taxmann's Income Tax Rules 2001 9. Details of transactions : Sl. No. Date of Transaction (DD- MM-YY) Name of Transacting Party (in block letters) 1. First Name 2. Middle Name 3. Surname (In case of non-individuals, full name be written. Leave one blank box between two words. PAN of Transacting Party (Refer to Instruction No. 5) Full Address (in block letters. Leave one blank box between two words) 1. Flat No.; 2. House/Premises No.; 3. Floor No.; 4. Building Name; 5. Block/Sector; 6.Road/Street; 7. Locality/colony; 8. City; 9. District; 10. State Code; 11. Pin (Refer to State Code in Instructions) Mode of transaction (Cash-C, Cheque-Q, Card-R, Demand Draft-, Others-O) Amount in Rs. (Rounded off to nearest Rupee) Transaction Code Address of Office/Branch of person (responsible for furnishing the Annual Information Return) where transaction took place - - 1. 1. 2. 2. 3. 4. 3. 5. 6. 7. 8. 9. 10. 11. INSTRUCTIONS FOR FILING ANNUAL INFORMATION RETURN 1. (i) This return (Part A and Part B) be furnished on computer-readable media being a floppy (3.5 inch and 1.44 MB) or CD-ROM (650MB or higher capacity) or Digital Video Disc, along with Part-A thereof on paper. (ii) In case the return filed
