FORM NO. 27F
[See rule 37G]
Application by a buyer, under sub-section (9) of section 
206C of the Income-Tax Act, 1961, for a certificate 
for collection of  tax at a lower rate

To
The Assessing Officer
__________________
__________________
__________________

Sir,
I, _____________________________________, do hereby request that a certificate may issued to the 
    [mention name of the buyer]
seller, being the person responsible for collecting  the tax from me in respect of the amount payable by me as the buyer of _________________________________________________________________________
[specify the nature of goods referred to in the Table in sub-section (1) of section 206C]
authorising him to collect income-tax at the rate of ___________________ percent at the time of debit of such amount to my account or receipt thereof from me, as the case may be.

2. The particulars of by income/other relevant details are as under: 
(a)	Name and address of the buyer.
(b)	Status (State whether individual, Hindu Undivided Family, firm body of individuals, etc.)
(c)	Residential status (whether resident/resident but not ordinarily resident/non-resident).
(d)	Permanent Account Number, if any.
(e)	Assessment year to which the payments relate.
(f)	Estimated total income of the previous year relevant to the assessment year referred to in (e) above.
(give the computation and basis thereof).
(g)	Total tax payable on the income at (f).
(h)	How the liability determined in column (g) is proposed to be discharged? (specify the amount to be paid by way of advance tax, tax deducted at source and tax collected at source).
(i)	Total income assessed in the last three assessment years and the total tax paid for each such year: 
                Assessment                       Total                                 Total
                Year                                   income (Rs.)                     tax (Rs.)
          (i)
          (ii)
          (iii)
(j)	Date and amount of advance tax, tax deducted at source and tax collected at source, if any, already paid so far.
(k)	Details of income claimed to be exempt and not  included in the estimated total income, referred to in (f) above, (please append a note giving reason for claiming such exemption).
(l)	Particulars of the amounts payable in respect of which the certificate is sought:

 Serial 
Number
	Full name and address
Of the seller	Date of sale with
Reference number 
Of such sale	Nature and description of the goods sold and details of sale	Amounts expected to 
Be debited/paid in pursuance of the sale during the current finacial year and each of the three immediately  succeeding years	
1	2	3	4	5	

I hereby declare that what is stated in this application is correct.

Place ___________                                                                       _______________________________
Date ____________                                                                      Signature of the buyer

Full Name _______________________
Designation ______________________