FORM NO.34A
(See rule 44 A)

APPLICATION FOR A CERTIFICATE UNDER  SECTION 230 A (1) OF THE INCOME TAX ACT, 1961.

To,

The Assessing Officer,

Sir,

I request that a Certificate under sub-section (1) of Section 230A of the Income-tax Act, 1961 be granted to me.

I give below the necessary particulars :

1.	Full name and address of  applicant (in block letters)

		
2.	Status (whether individual, H.U.F.etc.)

		
3.	Name of father (or husband)		
(To be filled in if the applicant is an individual)

		
4. 	(i) In case any assessment has been made on the applicant under the Indian Income-tax Act, 1992/Income-tax Act, 1961/Wealth-tax Act, 1957/Expenditure-tax Act, 1957/Gift-tax Act, 1958, name of Income Tax Circle/Ward/District in which such assessment in respect of the latest year was made.

     (ii) If no assessment has been made as stated above, whether a return has been submitted under ant of the said Acts for any year, and if so, the amount of income/wealth/expenditure/Gift  returned for each such year and the Circle/Ward/District where such return has been filed.

		
5. 	(i) Names and addresses of all firms or associations of persons or bodies of individuals in which applicant is a partner or member and the Income tax Circle/ Ward/ District in which each such firm or Association of Persons or body of individuals is assessed to tax.

		
    (ii) Names and addresses of all private limited companies in which applicant is or has been a director at any time after 1st April 1962 and the Circle/ Ward/ District in which each such company is assessed to tax.

		

6.  Particulars of existing tax liabilities  as on the date of the application under :

	C.A.P / Asst.Year	Amount Rs.	
(i) 	the Excess Profit tax Act, 1940
			
(ii) 	the Business Profits tax Act, 1947
			
(iii) 	the Indian Income tax Act, 1922
			
(iv) 	the Income tax Act, 1961
			
(v) 	the Wealth tax Act, 1957
			
(vi) 	the Expenditure tax Act, 1957
			
(vii) the Gift tax Act, 1958			

(If there is no existing liability against the applicant on the date of the application under any one of the aforesaid  Acts, this should be indicated by writing ‘NIL’ against the name of the relevant Act.)

7. (i) Nature of the documents, i.e. whether a deed of sale, gift, settlement, lease, etc. proposed to be registered		
   (ii) Nature of applicant’s right, title or interest to or in the property purported to be transferred, assigned, limited or extinguished.		
8. (i) In case the transferer is not the beneficial owner of or has no beneficial right or interest in the property proposed to be transferred, the name(s) and address(es) of the beneficial owner/ owners.
		
  (ii) In case the property is held by the applicant as a trustee agent, guardian or in any other capacity on behalf of any person or persons, the name(s) and address(es) of such other person/ persons.		
9. 	In a case where the applicant is a trustee, the particulars of all existing tax liabilities, if any, of the beneficiary(ies) of the trust as on the date of application, under :-
(To be filled in only if the beneficiary(ies) is/are chargeable to tax)		
	C.A.P/Asst.Year	Amount Rs.	
(i) 	the Excess Profits tax Act, 1940

(ii) 	the Business Profits tax Act, 1947

(iii) 	 the Indian Income tax Act, 1992

(iv) 	the Income tax Act, 1961

(v) 	the Wealth tax Act, 1957

the Expenditure Act, 1957
			
the Gift tax Act, 1958

(Particulars should be given in a separate sheet ifm there are more than one such beneficiary)			
10. Date on which the right, title or interest to or in the property concerned was acquired.			

11.	Cost of acquisition of the property . If the property was constructed by the applicant, cost of acquisition of the land and the cost of construction
		
12.	Particulars of the source or sources from which the cost of acquisition or construction was met.
		
13.	If the property or part thereof was acquired under any of the following modes of acquisition, the particular mode of acquisition  applicable to the applicant should be indicated :
		
      on any distribution of assets on the total of partial partition of a Hindu undivided family.

i.	Under a gift or will

ii.	by succession, inheritance or devolution or,

iii.	(a) on any distribution of assets on the dissolution of a firm, body of individuals or other association of persons, or,
             (b) under a transfer to a revocable or an irrevocable 
                   trust, or
             (c )   any other mode not covered by the above.      
		
14.	Name and address of the transferee, assignee, etc		
15.	(i) Full value of the consideration for which the property or the right, title or interest to or in the property is purported to be transferred.
     (ii)  If the transfer is to be without consideration, the value 
           for purposes of stamp duty.		
16.	Particulars of the property, i.e. its nature, extent, location, area, etc.		
Designation and address of the registering officer to whom the document has been/will be presented for registration.		
17.	In case the applicant has transferred any other property in the financial year, the following particulars of each such property and details of the transfer deed registered should be furnished
i.	particulars of property, i.e. it’s nature, extent, location and
       area
ii.	name and address of transferee or assignee
iii.	consideration stated in the instrument of transfer
date when the transfer deed was registered and 
       designation and address of the registering  officer		

I declare that to the best of my knowledge and belief the information furnished above is correct complete and is truly stated.

Place :	Yours faithfully,

Date :	Signature

NOTES : 1. This application should be signed: 
a.	in the case of an individual, by the individual  himself, where the individual is absent from India, by the individual concerned or by the some person duly authorised by him in his behalf; and where the individual is mentally incapacitated from attending to his affairs, by his guardian or by any other person competent to act on his behalf.

b.	in the case of a Hindu undivided family, by the Karta, and where the Karta is absent from India or is mentally incapacitated from attending to his affairs, by any other adult member of such family.

c.	in the case of a company or local authority, by the principal officer thereof

d.	in the case of a firm, by any partner thereof, not being a minor

e.	in the case of any other association or body of individuals, by any member of the association or body or the principal officer thereof, and

f.	in the case of any other person by that person or by some person competent  to act on his behalf;

2.	This application should be submitted  in duplicate and should be accompanied by a copy of the document which is to be registered.

To,

The Registrar/Sub-Registrar,

1.	The above mentioned applicant has been assessed/is assessable by me upto___________________

2.	He/she/it has                                          *no liabilities outstanding/made satisfactory provision for  payment of taxes due under the Income-tax Act, 1961, Indian Income - tax Act, 1922;  Excess Profits-tax Act, 1940; Business Profits-tax Act 1947; Wealth-tax Act, 1957; Expenditure-tax Act , 1957, and Gift-tax Act, 1958.

2.	*The registration of the document mentioned against Item No. 7(i) of the application will not prejudicially affect the recovery of any of the taxes due under the Income-tax Act, 1961,Indian income -tax Act, 1922; Excess Profits-tax Act, 1940; Business Profits-tax Act, 1947; Wealth-tax Act, 19578; Expenditure-tax Act, 1957, and Gift-tax Act, 1958

	Signature

	Designation : Assessing Officer
	Ward/District/Circle……………………

*Delete the inappropriate words or paragraphs