FORM NO. 13C
[See rule 28(2)]
Application for a certificate under section 194C(4) of the Income-tax Act, 1961,
relating to deduction of income-tax from payments made to contractors
and sub-contractors

To,
The Assessing Officer

Sir,

I, 
	[name]
of.
	[address]
do hereby declare that my total income (including income comprised in payments, of the nature referred to in section 194C of the Income-tax Act, 1961) computed in accordance with the provisions of that Act for the previous year relevant to the assessment year 19 .........  19 .......... was less than the minimum liable to income-tax   and I have no   amounted to Rs..........................................
reason to expect that my total income (computed as aforesaid) for the three assessment years next following will increase substantially.

2.	I, therefore, request that a certificate may be issued to the persons(s) responsible for paying any sum in pursuance of the contract, particulars of which are given in the Schedule

hereto, authorising him/them not to deduct income-tax at the time  to deduct income-tax at the rate of .......... percent of credit of such sum(s) to my account or, as the case may be, payment thereof to me.

3.	I hereby declare that what is stated in this application is correct.

	
	Signature

Date				
	Address

	Permanent Account Number

*Score out whichever is not applicable.

SCHEDULE

Sl. No.	Full name and address of the authority/ person with whom the contract was made	Date of the contract 	Nature of the contract	Date by which work on the contract would be completed	Sums expected to be credited/paid in pursuance of the contract during the current previous year and each of the three immediatley succeeding years	
1	2	3	4	5	6	

	

Date...............								........................................
									Signature