FORM NO. 55
[See rule 2C]
Application for approval of an association or institution for purposes of exemption under section 10(23), or continuance thereof for the year ________________

1. Name and address of the association/institution
2. Legal status, whether registered society/others. Please enclose a copy of certificate of registration
3. Date of inception or setting up of the association
4. Activities encouraged in India as reflected in the memorandum
(please specify each game/activity).
5. Activities, if any, encouraged outside India (give details)
6. Name and address of the office bearers
7. Total income of the association including voluntary contributions for the previous year relevant to the assessment year for or from which the exemption is sought
8. Amount of income referred to above that has been or deemed to have been utilised wholly and exclusively for the objects of the association [income deemed to have been utilised shall have the same meaning as assigned to it in sub-sections (1) and (1A) of section 11]
9. Amount accumulated for the purpose mentioned in Column (8) above
10. (i) Details of modes in which the funds of the association are invested or deposited showing the nature, value and income from the investment.
(ii) Details of funds not invested in the modes specified in section 11(5):
Sl. No. Name and address of the concern
In the case of a company,
number and class of shares
held
Nominal value of the
investment
Income from the investment
1 2 3 4 5
11. (i) Is the association carrying on any business (give details) ?
(ii) Is the business incidental to the attainment of its objectives ?
12. Details of nature, quantity and value of contributions (other than cash) and the manner in which such contribution has been utilised.
13. Details of shares, security or other property purchased by or on behalf of the association from any interested person as specified in sub-section (2) of section 13
14. Whether any part of the income or any property of the association was used or applied, in a manner which results directly or indirectly in conferring any benefit, amenity or perquisite (whether converted into money or not), or any interested person as specified in sub-section (3) of section 13. If so, details thereof
15. Amount deemed to be income of the association by virtue of subsection
(3) of section 11, as made applicable by the third proviso to section 10(23)
16. (i) State the assessment particulars including permanent account number/GIR number, name of the ward/circle
(ii) Last assessed and returned income
17. Has the association/institution distributed its income in the last three years among its members?. If so, please indicate reasons/purposes, i.e., whether as a loan, grant, subsidy or income
18. Enclose audited accounts including balance sheet, annual report, if any, with certified copies of income appropriation towards the object of the association.
Certified that the above information is true and to the best of my knowledge and belief.
Place _______________
Date ________________ Signature
Designation
Full address
Notes :
1. The application form should be sent to the Director General Income-tax (Exemptions) through the Commissioner of Income-tax having jurisdiction over the trust or institution. Four copies of the application form along with the
enclosures should be sent.
2. The applicant shall furnish any other documents or information as required by the DG Income-tax (Exemptions) or any authority authorised by the DG Income-tax (Exemptions).