Income Tax :- 80CCG Form A



Form A
[See paragraph 5(b)]
Declaration to be submitted by the investors to the depository participants for availing the benefits under the  Rajiv Gandhi Equity Savings Scheme.
Name of the Investor:
(first holder)
Address of the investor:
Permanent Account Number (PAN):

1. It is hereby certified that* ---
  
(a) I do not have a demat account and  I have not traded in any derivatives.
(b)I have demat account no _________________ in ____________________ depository participant but I have not traded in any equity shares or derivatives in this account.
(c)I have a joint demat account no _________________ in ____________________ depository participant but I am not the first account holder.

2. I hereby declare that I have read and understood all the terms and  conditions of the Rajiv Gandhi Equity Savings Scheme.

3. It is hereby verified that I am an eligible new retail investor for availing the benefits under the Rajiv Gandhi Equity Savings Scheme.

4. I undertake to abide by all the requirements and fulfill all obligations  under the Scheme, and will comply with all the terms and conditions of  the Scheme. 

5. I understand that, in case I fail to comply with any condition specified in  the Scheme, the benefits availed there under will be withdrawn and the  tax shall be payable by me accordingly. 


Signature of the Investor
Place:
Date:
         * Tick which ever is appropriate.
                        To read complete Notification No. 51 dated 23.11.2012 (Click Here)

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