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 ...................................