All about TDS on Dividend with format of Form 15G, 15H and Declarations

Essential guidelines regarding tax deduction at source (TDS) on dividends paid to shareholders. This article provides a comprehensive overview of TDS rates applicable to various categories of shareholders, along with exemptions and necessary documentation.

As you are aware that as per the Income-tax Act, 1961 (“the Act”), as amended by the Finance Act, 2020, dividends paid or distributed by a Company on or after 1 April 2020 shall be taxable in the hands of the shareholders. The Company shall therefore be required to deduct tax at source (TDS) at the time of making the payment of the said Dividend. The TDS rate may vary depending on the residential status of the shareholder and the documents submitted by them and accepted by the Company in accordance with the provisions of the Act.

TDS on dividend to Resident Shareholder and required documents

Category of Shareholder	Tax Deduction Rate	Exemption Applicability/Documents required
Any resident shareholder (With PAN)	As per Section 194 of the Act 10%	Update/Verify the PAN, and the residential status as per the Act if not already done, with the depositories (in case of shares held in demat mode) and with the Company’s Registrar and Transfer Agents – Link Intime India Private Limited (in case of shares held in physical –mode). If shareholder is classified as “specified person” as per the provision of Section 206AB, tax will be deducted at the higher of the following rates: 1. Twice the rate specified in the relevant provision of the Act; or 2. Twice the rate or rates in force; or 3. The rate of 5%. For the purpose of identifying whether shareholder is “Specified Person” as per the provisions of Section 206AB, the Central Board of Direct Taxes (CBDT) has prescribed the functionality for determining whether a person fulfils the conditions of being a “Specified Person” or not. Accordingly, the Company will verify from the above functionality provided by the CBDT whether a shareholder of the Company qualifies as a ”Specified Person” prior to applying relevant TDS rates.
No deduction of taxes in the following cases –
If aggregate dividend income to a resident Individual shareholder during FY 2024-25 does not exceed INR 5,000/-.
If shareholder is exempted from TDS provisions through any circular or notification and provides an attested copy of the PAN along with the documentary evidence in relation to the same.
Submitting Form 15G / Form 15H	NIL	Eligible Shareholder providing Form 15G (Annexure 1a) (applicable to any person other than a Company or a Firm) / Form 15H (Annexure 1b) (applicable to an Individual above the age of 60 years) – on fulfilment of prescribed conditions. PAN is mandatory to provide Form 15G/15H.
Order under Section 197 of the Act	Rate provided in the Order	Self-attested copy of Lower/NIL withholding tax certificate obtained from Income Tax authorities.
Insurance Companies: Public & Other Insurance Companies	NIL	Self-declaration that it has full beneficial interest with respect to shares owned, along with self-attested copy of PAN card and registration certificate (Annexure 2)
Corporation established by or under a Central Act which is, under any law for the time being in force, exempt from income- tax on its income.	NIL	Documentary evidence that the person is covered under Section 196 of the Act. (Annexure 2)
Mutual Funds	NIL	Self-declaration that they are specified in Section 10 (23D) of the Income Tax Act, 1961 along with self- attested copy of PAN card and registration certificate (Annexure 2)
Alternative Investment Fund (AIF) established in India	NIL	Documentary evidence that the person is covered by Notification No. 51/2015 dated 25 June 2015 (OR) Self declaration that its income is exempt under Section 10 (23FBA) of the Income Tax Act, 1961 and they are governed by SEBI regulations as Category I or Category II AIF along with self-attested copy of the PAN card and registration certificate (Annexure 2)
Recognized Provident Fund	NIL	Self-attested copy of a valid order from Commissioner under Rule 3 of Part A of Fourth Schedule to the Act, or self-attested valid documentary evidence (e.g. relevant copy of registration, notification, order, etc.) in support of the provident fund being established under a scheme framed under the Employees Provident Funds Act, 1952 needs to be submitted. (Annexure 2)
Approved Superannuation Fund	NIL	Self-attested copy of valid approval granted by the Commissioner needs to be submitted: a) under Rule 2 of Part B of Fourth Schedule to the Act (In case of Approved Superannuation Fund) b) under Rule 2 of Part C of Fourth Schedule to the Act (In case of Approved Gratuity Fund) (Annexure 2)
Approved Gratuity Fund	NIL
National Pension Scheme Trust	NIL
Other resident shareholder without PAN/Invalid PAN	20%	As per Section 206AA of the Act

 Please Note that:

1. Recording of the valid Permanent Account Number (PAN) for the registered Folio/DP id-Client Id is mandatory. In absence of valid PAN or PAN is not linked with Aadhar, tax will be deducted at a higher rate of 20% as per Section 206AA of the Act. In case the shareholder with PAN is identified as specified person under Section 206AB, higher rate of TDS as applicable shall be deducted.

2. Shareholders holding shares under multiple accounts under different status / category and single PAN, may note that, higher of the tax as applicable to the status in which shares held under a PAN will be considered on their entire holding in different accounts.

TDS on dividend to Non-resident Shareholders

Category of shareholder	Tax Deduction Rate	Exemption Applicability/ Documents required
Any non-resident shareholder [including Foreign Institutional Investors (FIIs) / Foreign Portfolio Investors (FPIs)]	As per Section 195/section 196D of the Act – 20% (plus applicable surcharge and cess) subject to applicable Treaty rat	Non-resident shareholders may opt for tax rate under Double Taxation Avoidance Agreement (“Tax Treaty”) read with Multilateral Instrument (“MLI”) provisions. The Tax Treaty rate shall be applied for tax deduction at source on submission of following documents to the Company: Self-attested Copy of the PAN Card Self-attested copy of Tax Residency Certificate (TRC) valid for the FY 2024-25 or for the calendar year 2024 obtained from the tax authorities of the Country of which the shareholder is resident Electronically furnished Form 10F and its acknowledgement from the Income-tax portal. In the absence of this form, relief under the tax treaty will be denied·    Self-declaration confirming not having a Permanent Establishment in India, eligibility to Tax Treaty benefit read with MLI provision, if any and do not / will not have place of effective management in India. (Annexure 3) Declaration to establish the genuineness of applicability of treaty provisions including provisions of General Anti-Avoidance Rules and Multilateral Instruments, if any (Annexure 4) Tax shall be deducted at 20% (plus applicable surcharge and cess) if any of the above-mentioned documents are not provided.
Submitting Order under     Section      195 /197 of the Act	Rate provided in the Order	Self-attested copy of Lower/NIL withholding tax certificate obtained from Income Tax authorities

 Please Note that:

1. The Shareholders holding shares under multiple accounts under different status / category and single PAN, may note that, higher of the tax as applicable to the status in which shares held under a PAN will be considered on their entire holding in different accounts.

2. Kindly note that the Company is not obligated to apply beneficial tax treaty rates read with MLI provision at the time of tax deduction / withholding on dividend amounts. Application of beneficial rate of tax treaty for the purpose of withholding taxes shall depend upon completeness and satisfactory review by the Company of the documents submitted by the non-resident shareholder.

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Annexure 1a Form 15G

INCOME-TAX RULES, 1962
^‘FORM NO. 15G
[See section 197A(1), 197A(1A) and rule 29C]

Declaration under section 197A(1) and section 197A(1A) to be made by an individual or a person (not being a company or firm) claiming certain incomes without deduction of tax

PART I

1. Name of Assessee (Declarant)							2. PAN of the Assessee‘
3. Status2		4. Previous year(P.Y.)‘ (for which declaration is being made)							5. Residential Status4
6. Flat/Door/Block No.			7. Name of Premises				8. Road/Street/Lane			9. Area/Locality
10. Town/City/District			11. State				12. PIN			13. Email
14. Telephone No. (with STD Code) and Mobile No.				15 (a) Whether assessed to tax under the Income-tax Act, 1961‘: (b) If yes, latest assessment year for which assessed					Yes                   No
16. Estimated income for which this declaration is made							17. Estimated total income of the P.Y. in which income mentioned in column 16 to be included‘
18. Details of Form No. 15G other than this form filed during the previous year, if any?
Total No. of Form No. 15G filed						Aggregate amount of income for which Form No.15G filed
19. Details of income for which the declaration is filed
Sl. No.	Identification number of relevant investment/account, etc.‘				Nature of income			Section under which tax is deductible			Amount of income

—————————
Signature of the Declarant^s

Declaration/Verification^°

*I/We……………………………………………………… do hereby declare that to the best of *m y/our knowl­edge and belief what is stated above is correct, complete and is truly stated. *I/We declare that the incomes referred to in this form are not includible in the total income of any other person under sections 60 to 64 of the Income-tax Act, 1961. *I/We further declare that the tax *on my/our estimated total income including *income/incomes referred to in column 16 *and aggregate amount of *income/incomes referred to in column 18 computed in accordance with the provisions of the Income-tax Act, 1961, for the previous year ending on ………………………… relevant to the assessment year ………………………… will be nil. *I/We also declare that *my/our *income/incomes referred to in column 16 *and the aggregate amount of *income/incomes referred to in column 18 for the previous year ending on ………………………… relevant to the assessment year ………………………… will not exceed the maximum amount which is not charge­able to income-tax.

Place: ………………………………….

Date: ………………………………….

……………………………………………………… 

Signature of the Declarant^s

PART II

[To be filled by the person responsible for paying the income referred to in column 16 of Part I]

1. Name of the person responsible for paying			2. Unique Identification No.”
3. PAN of the person responsible for paying	4. Complete Address		5. TAN of the person responsible for paying
6. Email	7. Telephone No. (with STD Code) and Mobile No. 8. Amount of income paid‘
9. Date on which Declaration is received (DD/MM/YYYY)		10. Date on which the income has been paid/credited (DD/MM/YYYY)

Place: ———————–

Date:————————-

———————————————–
Signature of the person responsible for paying
the income referred to in column 16 of Part I

*Delete whichever is not applicable.

¹As per provisions of section 206AA(2), the declaration under section 197A(1) or 197A(1A) shall be invalid if the declarant fails to furnish his valid Permanent Account Number (PAN).

²Declaration can be furnished by an individual under section 197A(1) and a person (other than a company or a firm) under section 197A(1A).

³The financial year to which the income pertains.

⁴Please mention the residential status as per the provisions of section 6 of the Income-tax Act, 1961.

⁵Please mention “Yes” if assessed to tax under the provisions of Income-tax Act, 1961 for any of the assessment year out of six assessment years preceding the year in which the declaration is filed.

⁶Please mention the amount of estimated total income of the previous year for which the declaration is filed including the amount of income for which this declaration is made.

⁷In case any declaration(s) in Form No. 15G is filed before filing this declaration during the previous year, mention the total number of such Form No. 15G filed along with the aggregate amount of income for which said declaration(s) have been filed.

⁸Mention the distinctive number of shares, account number of term deposit, recurring deposit, National Savings Schemes, life insurance policy number, employee code, etc.

⁹Indicate the capacity in which the declaration is furnished on behalf of a HUF, AOP, etc.

¹⁰Before signing the declaration/verification, the declarant should satisfy himself that the information furnished in this form is true, correct and complete in all respects. Any person making a false statement in the declaration shall be liable to prosecution under section 277 of the Income-tax Act, 1961 and on conviction be punishable-

(i) in a case where tax sought to be evaded exceeds twenty-five lakh rupees, with rigorous imprisonment which shall not be less than six months but which may extend to seven years and with fine;

(ii) in any other case, with rigorous imprisonment which shall not be less than three months but which may extend to two years and with fine.

¹¹The person responsible for paying the income referred to in column 16 of Part I shall allot a unique identification number to all the Form No. 15G received by him during a quarter of the financial year and report this reference number along with the particulars prescribed in rule 31A(4)(vii) of the Income-tax Rules, 1962 in the TDS statement furnished for the same quarter. In case the person has also received Form No.15H during the same quarter, please allot separate series of serial number for Form No.15G and Form No.15H.

¹²The person responsible for paying the income referred to in column 16 of Part I shall not accept the declaration where the amount of income of the nature referred to in sub-section (1) or sub-section (1A) of section 197A or the aggregate of the amounts of such income credited or paid or likely to be credited or paid during the previous year in which such income is to be included exceeds the maximum amount which is not chargeable to tax. For deciding the eligibility, he is required to verify income or the aggregate amount of incomes, as the case may be, reported by the declarant in columns 16 and 18.

Notes

1. Substituted by IT (Fourteenth Amdt.) Rules 2015, w.e.f. 1-10-2015. Earlier Form No. 15G was inserted by the IT (Fifth Amdt.) Rules, 1982, w.e.f. 21-6-1982 and later on amended by the IT (Fifth Amdt.) Rules, 1989, w.r.e.f. 1-4-1988, IT (Fourteenth Amdt.) Rules, 1990, w.e.f. 20-11-1990 and IT (Twelfth Amdt.) Rules, 2002, w.e.f. 21-6-2002 and substituted by the IT (Eighth Amdt.) Rules, 2003, w.e.f. 9-6-2003 and IT (Second Amdt.) Rules, 2013, w.e.f. 19-2-2013.

*****

Annexure 1b Form 15H

¹FORM NO. 15H
[See section 197A(1C) and rule 29C]
Declaration under section 197A(1C) to be made by an individual who is of the age of sixty years or more claiming certain incomes without deduction of tax.

PART I

1. Name of Assessee (Declarant)

2. Permanent Account Number or Aadhaar Number of the Assessee1

3. Date of Birth2(DD/MM/YYYY)

4. Previous year(P.Y.)3 (for which declaration is being made)

5. Flat/Door/Block No.

6. Name of Premises

7. Road/Street/Lane

8. Area/Locality

9. Town/City/District

10. State

11. PIN

12. Email

13. Telephone No. (with STD Code) and Mobile No.

14 (a) Whether assessed to tax4:

Yes

No

(b) If yes, latest assessment year for which assessed

15. Estimated income for which this declaration is made

16. Estimated total income of the P.Y. in which income mentioned in column 15 to be included5

17. Details of Form No.15H other than this form filed for the previous year, if any6

Total No. of Form No.15H filed

Aggregate amount of income for which Form No.15H filed

18. Details of income for which the declaration is filed

Sl. No.

Identification number of relevant investment/account, etc.7

Nature of income

Section under which tax is deductible

Amount of income

…………………………………….
Signature of the Declarant

Declaration/Verification⁸

I ………………………………………………………. do hereby declare that I am resident in India within the

meaning of section 6 of the Income-tax Act, 1961. I also hereby declare that to the best of my knowledge and belief what is stated above is correct, complete and is truly stated and that the incomes referred to in this form are not includible in the total income of any other person under sections 60 to 64 of the Income-tax Act, 1961. I further declare that the tax on my estimated total income including *income/incomes referred to in column 15 *and aggregate amount of *income/incomes referred to in column 17 computed in accordance with the provisions of the

Income-tax Act, 1961, for the previous year ending on ……………………………………. relevant to the assessment year………………………………. will be nil.

Place:………………………………..

Date:……………………………..

…………………………………….
Signature of the Declarant

PART II

[To be filled by the person responsible for paying the income
referred to in column 15 of Part I]

1. Name of the person responsible for paying			2. Unique Identification No.9
3. Permanent Account Number or Aadhaar Number of the person responsible for paying	4. Complete Address			5. TAN of the person responsible for paying
6. Email	7. Telephone No. (with STD Code) and Mobile No.			8. Amount of income paid10
9. Date on which Declaration is received (DD/MM/YYYY)		10. Date on which the income has been paid/credited (DD/MM/YYYY)

Place:…………………………………

Date:………………………………….

……………………………………………………………………..
Signature of the person responsible for paying the
income referred to in column 15 of Part I

*Delete whichever is not applicable.

1. As per provisions of section 206AA(2), the declaration under section 197A(1C) shall be invalid if the declarant fails to furnish his valid Permanent Account Number or Aadhaar Number.

2. Declaration can be furnished by a resident individual who is of the age of 60 years or more at any time during the previous year.

3. The financial year to which the income pertains.

4. Please mention “Yes” if assessed to tax under the provisions of Income-tax Act, 1961 for any of the assessment year out of six assessment years preceding the year in which the declaration is filed.

5. Please mention the amount of estimated total income of the previous year for which the declaration is filed including the amount of income for which this declaration is made.

6. In case any declaration(s) in Form No. 15H is filed before filing this declaration during the previous year, mention the total number of such Form No. 15H filed along with the aggregate amount of income for which said declaration(s) have been filed.

7. Mention the distinctive number of shares, account number of term deposit, recurring deposit, National Savings Schemes, life insurance policy number, employee code, etc.

8. Before signing the declaration/verification, the declarant should satisfy himself that the information furnished in this form is true, correct and complete in all respects. Any person making a false statement in the declaration shall be liable to prosecution under section 277 of the Income-tax Act, 1961 and on conviction be punishable—

(i) in a case where tax sought to be evaded exceeds twenty-five lakh rupees, with rigorous imprisonment which shall not be less than six months but which may extend to seven years and with fine;

(ii) in any other case, with rigorous imprisonment which shall not be less than three months but which may extend to two years and with fine.

9. The person responsible for paying the income referred to in column 15 of Part I shall allot a unique identification number to all the Form No. 15H received by him during a quarter of the financial year and report this reference number along with the particulars prescribed in rule 31A(4)(vii) of the Income-tax Rules, 1962 in the TDS statement furnished for the same quarter. In case the person has also received Form No.15G during the same quarter, please allot separate series of serial number for Form No.15H and Form No.15G.

10. The person responsible for paying the income referred to in column 15 of Part I shall not accept the declaration where the amount of income of the nature referred to in section 197A(1C) or the aggregate of the amounts of such income credited or paid or likely to be credited or paid during the previous year in which such income is to be included exceeds the maximum amount which is not chargeable to tax after allowing for deduction(s) under Chapter VI-A, if any, or set off of loss, if any, under the head “income from house property” for which the declarant is eligible. For deciding the eligibility, he is required to verify income or the aggregate amount of incomes, as the case may be, reported by the declarant in columns 15 and 17.

¹[Provided that such person shall accept the declaration in a case where income of the assessee, who is eligible for rebate of income-tax under section 87A, is higher than the income for which declaration can be accepted as per this note, but his tax liability shall be nil after taking into account the rebate available to him under the said section 87A.]

Notes

1. Substituted by the IT (Fourteenth Amdt.) Rules, 2015, w.e.f. 1-10-2015. Earlier Form No. 15H was amended by the IT (Fifth Amdt.) Rules, 1982, w.e.f. 21-6-1982, IT (Fifth Amdt.) Rules, 1989, w.r.e.f. 1-4-1988, IT (Fourteenth Amdt.) Rules, 1990, w.e.f. 20-11-1990, IT (Twelfth Amdt.) Rules, 1992, w.e.f. 1-6-1992, IT (Seventh Amdt.) Rules, 1995, w.e.f. 1-7-1995, IT (Thirty-second Amdt.) Rules, 1999, w.e.f. 19-11-1999, IT (Twelfth Amdt.) Rules, 2002, w.e.f. 21-6-2002, IT (Eighth Amdt.) Rules, 2003, w.e.f. 9-6-2003, IT (Fourteenth Amdt.) Rules, 2003, w.e.f. 1-8-2003 and IT (Second Amdt.) Rules, 2013, w.e.f. 19-2-2013.

1. Inserted by Income-tax (4th Amendment) Rules, 2019, w.e.f. 22-5-2019.

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Annexure 2 Resident Tax Declaration

ANNEXURE – 2 Declaration

Date: ____________

To

XYZ LIMITED

_________

Subject: Declaration regarding Category and Beneficial Ownership of shares

Ref: PAN – __________________________________________(Please specify the PAN of Shareholder) Folio Number / DP ID/ Client ID –______________________(Please specify all the account details) With reference to the captioned subject, and in relation to the appropriate withholding of taxes on the Dividend payable to me / us by XYZ Limited (the Company), I / We hereby declare as under:

1. We,____________________________________ (Please mention full name of the shareholder), holding
share/shares of the Company as on the record date, hereby declare that I am /we are tax resident of India for the period April 1, 2024 to March 31, 2025 (Indian Fiscal Year).

2. We hereby declare that (Select Applicable and fill details as required) We are Insurance Company and are the beneficial owner of the share/shares held in the Company; and we are submitting self-attested copy of PAN Card and registration certificate

We are Mutual Fund specified in Section 10(23D) of the Income Tax Act, 1961 and are the beneficial owner of the share/shares held in the Company; and we are submitting self-attested copy of PAN Card and registration certificate.

We are Alternative Investment fund established in India and are the beneficial owner of the share/shares held in the Company; and our income is exempt under Section 10(23FBA) of the Act and are governed by SEBI regulations as Category I or Category II AIF; and we are submitting self-attested copy of the PAN card and registration certificate.

We are_________________________ (Please mention category of the entity) and are the beneficial owner of the share/shares held in the Company; and are not subject to withholding tax under section 196 of the Income Tax Act; and we are submitting self-attested copy of the documentary evidence supporting the exemption status along with self-attested copy of PAN card.

We are ____________________________________ (Recognised Provident Fund/Approved Superannuation Fund/Approved Gratutity Fund/National Pension Scheme / any other entity entitled to exemption from TDS) and are the beneficial owner of the share/shares held in the Company; and are exempted from TDS deduction under ________________________________ (Please specify the relevant Section/Rules giving exemption under the Income Tax Act); and we are submitting self-attested copy of the documentary evidence supporting the exemption status (e.g. relevant copy of registration, notification, order, etc.) along with self-attested copy of PAN card.

3. I/ We further indemnify the Company for any penal consequences arising out of any acts of commission or omission initiated by the Company by relying on my/ our above averment.

4. I/We hereby confirm that the above declaration should be considered to be applicable for all the shares held in the Company under PAN/ accounts declared in the form.

Thanking you.
Yours faithfully,
For (Name of the shareholder)
<<insert signature>>

Authorized Signatory

*****

Annexure 3 Letter Foreign Company has no Permanent Establishment in India and Self declaration owner

Date:

To

XYZ Limited,
________
________

Subject: Declaration regarding Tax Residency and Beneficial Ownership of shares

Ref: PAN – Mention PAN of Shareholder

Folio Number / DP ID/ Client ID – Mention all the account details

With reference to the captioned subject, and in relation to the appropriate withholding of taxes on the Dividend payable to me / us by [Name of Company] (the Company), I / We hereby declare as under:

1. I / We, Full name of the shareholder______________________________________ , holding
share/shares of the Company as on the record date, hereby declare that I am /we are tax resident of country name for the period April 2024-March 2025 (Indian Fiscal Year) as per tax treaty between India and country name (hereinafter referred to as ‘said tax treaty’).

2. I / We hereby declare that, I am /we are the beneficial owner of the share/shares held in the Company as well as the dividend arising from such shareholding; and I/ we have the right to use and enjoy the dividend received/ receivable from the above shares and such right is not constrained by any contractual and/ or legal obligation to pass on such dividend to another person.

3. I/We confirm that I/We are entitled to claim the benefits under the Treaty as modified by the multilateral convention to implement tax treaty related measures to prevent base erosion and profit shifting (MLI) including but not limited to the Principal Purpose Test (PPT), limitation of benefit clause (LOB), Simplified Limitation of Benefits (SLOB), period of holding of shares etc. as applicable. We specifically confirm that my affairs / affairs were not arranged such that the main purpose or the principal purpose thereof was to obtain tax benefits available under the applicable tax treaty.

4. I/We confirm that I/We have not entered into an impermissible avoidance arrangement i.e. an arrangement, the main purpose or one of the main purposes of which is to obtain a tax benefit and it (a) creates rights, or obligations, which are not ordinarily created bet-ween persons dealing at arm’s length (b) results, directly or indirectly, in the misuse, or abuse, of the provisions of this Act (c) lacks commercial substance or is deemed to lack commercial substance under section 97, in whole or in part; or (d) is entered into, or carried out, by means, or in a manner, which are not ordinarily employed for bona fide purposes.

5. I/We hereby furnish a copy of valid Tax Residency Certificate dated______________ having Tax Identification number___________ issued by___________ along with a copy of Form 10F duly filled and signed for the period April 2024-March 2025.

6. I/We further declare that I/we do not have and will not have any taxable presence, fixed base or Permanent Establishment in India as per the said tax treaty during the period April 2024 – March 2025.

7. If, I /We have any PE or fixed base in India as construed under relevant Articles of the applicable tax treaty but the dividend income receivable by me/us from investment in the shares of the Company is not effectively connected to said permanent establishment in India. Further I/We hereby declare and confirm that I/We do not fall under the definition of ‘specified person’ as provided in section 206AB of the IT Act.

8. I/ We further indemnify the Company for any penal consequences arising out of any acts of commission or omission initiated by the Company by relying on my/ our above averment.

9. I/We hereby confirm that the above declaration should be considered to be applicable for all the shares held in the Company under PAN/ accounts declared in the form.

The shareholders are required to provide a Declaration strictly as per the specified format given above, failing which the Company reserves the right to deny the Treaty benefits.

Thanking you.
Yours faithfully,
For Name of the shareholder
<<insert signature>>

Authorized Signatory – Name and designation
Contact address:__________________________________________________ [Please insert]
Email address:____________________________________________________ [Please insert]
Contact Number:__________________________________________________ [Please insert]
Tax Identification Number___________________________________________ [Please insert]

Note: Kindly strikethrough whichever is not applicable

(*In case of any Authorised Signatory being other than Director/ Managing Director, please attach the valid Power of Attorney authorising the individual as an Authorised Signatory)

The shareholders are required to provide a Declaration strictly as per the specified format given above, failing which the Company reserves the right to deny the Treaty benefits.

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Annexure 4 Self – declaration for claiming beneficial provisions of Double Taxation Avoidance Agreement 

Self – declaration for claiming beneficial provisions of Double Taxation Avoidance Agreement read with Multilateral instrument, wherever applicable for the period April 1, 2024 to March 31, 2025

(To be declared by non-resident shareholder for availing the benefits of lower tax deduction under Section 90 of the Indian Income Tax Act read with the provisions of the Double Tax Avoidance Treaty with India read along with Multilateral Instrument)

Date:

To,

XYZ Limited
________

Ref: Declaration for claiming beneficial provisions of Double Taxation Avoidance Agreement read with Multilateral instrument, wherever applicable for the period April 1, 2024 to March 31, 2025

Dear Sir,

I / We,____________ (name of shareholder) do hereby solemnly declare as follows:

a) I / We qualify as tax resident of _______________ (name of the country) in terms of India- ______________ (name of country) Double Taxation Avoidance Agreement (“Tax Treaty”) read with Multilateral instrument, wherever applicable for the period April 1, 2024 to March 31, 2025;

b) I / We do not qualify as ‘resident’ of India under section 6 of the Indian Income-tax Act, 1961 (“Act”) for the period April 1, 2024 to March 31, 2025;

c) We are eligible to claim benefits of the India and_________ (name of country) Tax Treaty,
read with the provisions laid down in Multilateral Instrument (MLI), wherever applicable for the period April 1, 2024 to March 31, 2025;

d) I / We are the beneficial owner of the investments made by us in the shares of Page Industries Limited and also for any income receivable by us from such investments for the period April 1, 2024 to March 31, 2025;

e) I / We declare that my/ our affairs in relation to the investments in shares of Page Industries Limited is/ are not arranged with the main purpose of obtaining tax benefit under the treaty and should not be an impermissible avoidance arrangement so as to attract General Anti-Avoidance rules under the Income-tax Act, 1961.

f) I / We declare that following are correct under MLI – strike out whichever is not applicable

• Article 7(1) – Principal Purpose Test (PPT)

I / We declare that I am/ We are the beneficial owner of the investments made by me/us in in the shares of PAGE INDUSTRIES Limited and any income receivable by me/us from such investments. I am/ We are eligible to claim the benefits of the India – Tax Treaty (Please insert relevant treaty) and my/ our affairs in relation to the investments in shares of Page Industries Limited, will satisfy the Principle Purpose Test and Limitation of Benefit criteria, if any, under the Tax Treaty read with the Multilateral Instrument, if applicable

• Article 7(6) – Simplified Limitation of Benefits Test (SLOB) read with Article 7(8) to Article 7(13) of the MLI

I / We hereby declare that I / we am / are a qualified person as defined through paragraphs 9 to 13 of Article 7 of the MLI. The specific paragraph under which I/we am/are a qualified person is paragraph 10; 11; 12; 13]

• Article 8 – Period of holding of Investment.

I am/We are the beneficial owner of the investments made by me/us in the shares of Page Industries Limited for an uninterrupted period of 365 days prior to and including the date of payment of the dividends.

g) I / We further indemnify Page Industries Limited for any penal consequences arising out of any acts of commission or omission initiated by the Company by relying on our above averment.

h) I/We undertake to intimate Page Industries Limited immediately in case of any alteration in the aforesaid declaration including change in tax residential status, etc.

Thanking you,
Yours Sincerely,

For_______ (name of organisation/ individual)
<<Signature>>

Name:___________ (name of authorized person / individual)
____________ (designation) – applicable in case of non-individual