FORM NO. I.T.C.P. 23
[See rule 26 of the Income -tax (Certificate Proceedings) Rules, 1962]
Bond (Sapurdnama)

Statement of Shri aged, son of Shri , residing at, I have received notice in Form No. I.T.C.P. 1 (Form No. 57 of the Income-tax Rules) that arrears amounting to Rs. are due from me in respect of certificate No. dated drawn up by the undersigned /Tax Recovery Officer, a certified copy of which has been forwarded by the said Tax Recovery Officer to the Tax Recovery Officer, , under section 223(2) of the Income-tax Act, 1961, I offer herewith a sum of Rs. towards the said arrears. Regarding the balance of Rs. of the arrears as well as costs, expenses and charges amounting to Rs. , I undertake to pay the same in monthly instalments of Rs. each payable not later than the day of each month commencing from . Along with each instalment I also undertake to pay the interest payable under section 220(2) of the Income-tax Act, 1961. I undertake not to commit any default in the payment of the instalments. I agree that if I commit any default in paying any one of the instalments within the time aforesaid, the entire amount due from me on the date of the default may be recovered in entirety by such measures as the Tax Recovery Officer, , considers necessary. I specify herein my assets as on this day and I agree not to sell, give away, transfer, mortgage, or otherwise alienate or encumber these assets in any way, until the entire amount due from me is paid to the Tax Recovery Officer, , in full. I agree that in the meanwhile, these assets may continue to remain attached if considered necessary. I also agree to furnish two solvent sureties who will execute a surety bond in the form approved by the Tax Recovery Officer, , for the due payment by me of the aforesaid dues in instalments as agreed to herein.
DETAILS OF ASSETS AS ON THIS DAY
Before me
(Signature) (Signature)
Name) (Name)
(Designation)
Date Date
(SEAL)
Score out portion in italics, if not applicable.