FORM. NO. 15C
[See rule 29B]
Application by a banking company for a certificate under section 195(3)
of the Income-tax Act, 1961, for receipt of interest and other
sums without deduction of tax
To
The Assessing Officer,
…………………………
…………………………
Sir,
I, .........:...........................……………………………………………….being  the  principal  officer
of…………………………………………………………………..hereby declare:
[name of the banking company]
(a) that................................, is a banking company which is neither an  Indian company nor a com-
pany which has made the prescribed arrangements for the declaration and payment of dividends
within India and which is operating in India through a branch(es) at...........................;
(b) that the head office of the said company is situated at....................................……………
[name of the place
…………………………………………..;
and country]
(c) that the said company is entitled to receive interest (other than ‘Interest on securities’) and other
sums not being dividends, chargeable under the provisions of the Income-tax Act, 1961, during
the financial year …... - …....;
(d) that the company fulfils all the conditions laid down in rule 29B of the Income-tax Rules, 1962.
I, therefore, request that a certificate may be issued authorising the said company to receive interest other
than “Interest on securities” and other sums not being dividends, without deduction of tax under sub-section
(1) of section 195 of  the Income-tax Act, 1961, during the financial year ..... - …..... I hereby declare that
what is stated in this application is correct.
Date .......................
 …………………………..
Signature
…………………………..
…………………………..
Address