FORM NO. 10HA
[See rule 29AA]
Form of certificate under second proviso to section 80-O of the Income-tax Act, 1961
PART A
(CERTIFICATE OF FOREIGN INWARD REMITTANCE TO BE GIVEN BY BANK)

_______________________________Bank
No.______________ Ref. No_____________
Date_______________
1. We certify that we have received the following remittance and proceeds thereof were paid :
(a) to beneficiary M/s_____________________________________________(Name and address)
on____________________________________________________________
By Cash___________________By Pay-Order________________
By Credit to Current/ Saving/ Cash Credit Account with us/ with our____________________office for
beneficiary's account, or
(b) to_________________________Bank_______________________on_____________________ for
credit of beneficiary of M/s.__________________________________________(Name and address)
Account
2. Name and address of remmiter__________________________________________________________
3. Name and address of remitting bank______________________________________________________
4. Demand Draft/ Telegraphic Transfer/ Money Transfer No.____________Dated_________Foreign currency
amount_________________Rupee equivalent_______________(Rupees_________________________)
Favouring_________________________
5. Exchange rate applied_________________________________
6. Purpose of remittance as stated by remitter / beneficiary________________________________
We also certify that the payment thereof has/ has not been received in non-convertible rupees or under any
special trade or payments agreement.
We confirm that we have obtained reimbursement in any manner approved by the Reserve Bank of India and
according to the laws.
For ______________ Bank
Strike out whichever is inapplicable.
To
Manager
Countersigned
(name and designation)
(Address)
PART B
(CERTIFICATE TO BE GIVEN BY ELIGIBLE ASSESSEE)
1. Inward remittance received during the previous year
2. (i) Whether the convertible foreign exchange in (1) was brought into India
within a period of six months from the end of the previous year
Yes /No
(ii) If not, whether it was brought into India within such further period in the
previous year as allowed by the Competent Authority
Yes /No
(iii) Specify the amount and the relevant previous year in case such amount is brought into India in convertible foreign exchange beyond the period of six months from the end of relevant previous year and with the approval of the competent authority, where such amount relates to any other previous year. (Specify the authority and the period upto which the approval has been accorded.)
I certify that the total deduction of Rs.____________________claimed under section 80-O in respect of assessment year_______________is correctly claimed in accordance with the provisions of the section.
I hereby certify that the above particulars contained in Part A and Part B of this certificate are true and correct to the best of my knowledge and belief and nothing has been concealed therein.
Place _______________
Date ________________ (Signature)
Strike out whichever is inapplicable.