FORM NO. 27G
[See rule 37H]

Certificate under sub-section (9) of section 206C of the 
Income-tax Act, 1961, relating to collection 
Of tax at source

Certificate No.________________

*To                                                                                         Income-tax office,
 ________________________                                            _____________________________
________________________                                             _____________________________
                                                                                             Date _________________________

I hereby authorise you to debit the amount payable by M/s._____________________________________
____________________________________________________________________________to his
                                            (name of the buyer)
account or to receive, as the case may be, such amount from the said buyer on account of sale _________
______________________________________________
[specify the nature of goods referred to in the table in sub-section (1) of  section 206C]
the particulars of which are given in the schedule below, after collecting income-tax at the rate of _______
_______________ percent of such amount.

2. The certificate shall remain in force for the assessment year ___________________ unless it is cancelled by me under intimation  to you before the said period.

SCHEDULE
Serial 
number

	Full name & Address of the seller	Date of sale with reference
Number of such sale	Nature and description of the goods sold and details of sale	Amount expected to be 
Debited/received in pursuance of the sale during the current financial year	
1	2	3	4	5	

				

(SEAL)                                                                                                             _________________________
                                                                                                                       
                                       Assessing Officer

*Name and Address of person responsible for collecting tax.