FORM NO. 30C
[See rule 43]
Form for furnishing the details under section 230(1A) of the Income-tax Act, 1961
To
__________________
[Designation of the Prescribed Authority]
Sir,
 I give below the necessary particulars as required under sub-section (1A) of
section 230:
1. Full Name (in Block letters) :
2. Present Address
 :
3. Permanent Address
 :
4. Name of *father/husband
 :
5. Nature of business/profession in India :
6. *The PAN allotted under section 139A
Or
*My total income is not chargeable to
income-tax (certificates as per annexure)
Or
*I am not required to obtain a PAN under
the Income-tax Act, 1961 (certificate as per
annexure)
7. The purpose of visit outside India :
8. Estimated period of stay outside India :
9. Passport No./Emergency Certificate No. ….
(a)   Issued on (date) …………………..
(b)   From (Place) ……………..
I declare that to the best my knowledge and belief, the information furnished is
correct and truly stated.
Place :  _________
 Yours faithfully
Date :    _________
 Applicant
*Delete whichever is not applicable.

ANNEXURE
Certificate to be furnished by a person domiciled in India whose total income is
not chargeable to income-tax or who is not required to obtain a PAN under the
Income-tax Act
I __________ *son/daughter/wife of _______________ resident of ______ do
hereby certify that:
(a) *No permanent account number has been allotted to me under the
provisions of section 139A of the Income-tax Act, 1961;
OR
(b) *My total income computed in accordance with the provisions of the
Income-tax Act, 1961 is not chargeable to tax;
OR
(c) *I am not required to obtain a permanent account number under the
provisions of Income-tax Act, 1961
 ………………………………………..
(Signature of the person giving the certificate)
Name (in Block letters)_________________
            Address ____________________________
VERIFICATION
I _____________ do hereby certify that to the best of my knowledge and belief
what is stated above is correct and truly stated.
Verified today the _______ day of ________________
Place:
 ………….…………………………..
(Signature of the person giving the certificate)
           Name (in Block letters) _________________
           Address ____________________________
*Delete whichever is not applicable.”;