FORM NO. 34F
[See rule 44G]
Form of application for giving effect to the terms of any agreement under clause
(h) of sub-section (2) of section 295 of the Income-tax Act, 1961
To
The Competent Authority of India
Foreign Tax and Tax Research,
Department of Revenue,
Ministry of Finance and Company Affairs,
New Delhi
Sir,
Whereas the applicant is aggrieved by the action of the tax authority of
_____________________________________________________ (name of the country) for the reasons given here under, the matter may kindly be taken up with the competent authority of___________________________________ (name of the country) under Article_______________________________ of the ________________________________ (specify the agreement)
between India and ____________________________________________ (name of the country). The relevant
details in this regard are as under:
Name of the Applicant in Block Letters Permanent Account No.
Ward/Circle
Office Address in Block Letters
Telephone No. Assessment Year
Residential Address in Block Letters Previous year(s) ending on
[If applicable]
Telephone No.
Status
Name and Designation of Tax Authority in
the Foreign State (Treaty Partner)
Date of the notice or order giving rise to
the action
Is the order/action of the income-tax
authority of the country outside India not in
accordance with the agreement? If so, the
reasons thereof.
(attach separate sheet if required)
The following documents in support of our claim are enclosed:—
(1) Copy of notice or order giving rise to action
(2) __________________________________________________________
(3) ___________________________________________________________
Verification
I,_________________________________________ son/daughter/wife of Shri
_____________________________________________ solemnly declare that to the best of my knowledge and
belief, the information given in this application and the annexures and statements accompanying it is correct and complete and particulars shown therein are truly stated and relate to the previous year(s) relevant to the assessment year ___________________.
2. I also declare that to the best of my knowledge, I have not concealed any fact or information which could be
relevant for deciding my application.
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3. I further declare that I am making this application in my capacity as (designation) and that I am competent to
make this application and verify it.
Date ______________
Place ______________ (Signature)