FORM NO. 13E
[See rule 28(5)]
Application for a certificate under section 194J(2) of the Income-tax Act, 1961, relating to deduction of income-tax from payments of fees for professional or technical services 
To,
The Assessing Officer,

Sir,

I,,
		[name] 
of							 do hereby declare that 
	[address] 
my total income (including income comprised in payments of the nature referred to in section 194J 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/amounted to Rs............... and I have no reason to expect that my total income (computed as aforesaid) for three assessment years next following will increase substantially. 
2. I, therefor, request that a certificate may be issued to the person(s) responsible for paying any sum by way of fees for *professional/technical services. Particulars of which are given in the Schedule hereto, authorising *him/them not to deduct income-tax/to deduct income-tax at the rate of .............................per cent at the  time of credit of such income 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.

Date	
	Signature 
							
								Address
							
								Permanent Account Number  

SCHEDULE 
Sr. No.	Name and address of person(s) responsible for paying fees for *professional/technical services	Amount of *professional/technical services	

			

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

*Score out whichever is not applicable.