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Form No. 10fa

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"FORM No.

10FA
[See rule 21AB (3)]
Application for Certificate of residence for the purposes of an agreement under section 90 and
90A of the Income Tax Act, 1961
To
The Assessing Officer,
_________________,
_________________,
_________________,
Sir,
I request that a certificate of residence in Form No. 10FB be granted in my case/in the case of
________________________ [for person other than individual]
2. The relevant details in this regard are as under: (i) Full Name and address of the applicant
(ii) Status (State whether individual, Hindu undivided
family, firm, body of individuals, company etc.)
(iii) Nationality (in case of individual)
(iv) Country of incorporation/registration (in case of
others).
(v) Address of the applicant during the period for which
TRC is desired.
(vi) Email ID
(vii) PAN/ TAN No. (if applicable)
(viii Basis on which the status of being resident in India is
) claimed.
(ix) Period for which the residence certificate is applicable
(x) Purpose of obtaining Tax Residency Certificate (must
be specified)
(xi) Any other detail

http://taxguru.in/

3. The following document in support are enclosed: (1)


(2)
(3)
VERIFICATION
I, ____________ [full name in block letters] __________ son/daughter of
________________________, in the capacity of ________________ [designation for person
other than individual], verify that to the best of my knowledge and belief, the information given
in this form is correct and complete and that the other particulars shown therein are truly stated.
Verified today the ____________________ day of ____________
Place

Signature of the Applicant ____________________


Name____________________________________

http://taxguru.in/

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