FORM NO. 34B APPLICATION FOR SETTLEMENT OF CASES (See section 245C of the Income-tax Act, 1961 and rules 44C and 44CA of the Income-tax Rules, 1962)

FORM NO. 34B

APPLICATION FOR SETTLEMENT OF CASES (See section 245C of the Income-tax Act, 1961 and rules 44C and 44CA of the Income-tax Rules, 1962)

In the Settlement Commission At ................... Bench Settlement Application No. .........20.....20......... PAN

Name

PART-A PERSONAL INFORMATION

Flat/Door/Block No.

Name of Premises/ Building/Village Area/Locality State Pin Code (i ) (ii) (iii) ( iv ) (v) ( vi ) ( vii )

Status

(Tick) ;

Road/Street/Post

Office

Town/City/District

E-mail Address

STD code and Phone Number ( )

Individual Hindu undivided family Company Firm Cooperative Society Local Authority Association of persons Body of individuals not covered by (v) or (vi)

PART-B ASSESSMENT JURISDICTION AND FILING STATUS

1.

Designation of Assessing Officer (Ward/Circle)

2.

The Commissioner having jurisdiction over the applicant

3.

Assessment year(s) in connection with which the application for settlement is made and the date of filing the return

1.

PART-C PARTICULARS OF INCOME DISCLOSED AND PAYMENT OF ADDITIONAL TAX AND INTEREST

The date from which the proceedings are pending. (Assessment year wise)

2.

Particulars of the issues to be settled, nature and circumstances of the case. (Assessment year wise)

3.

Full and true disclosure of income which has not been disclosed before the Assessing Officer. (Assessment year wise)

4.

The additional amount of income-tax payable on income referred to in (3). (Assessment year wise)

5.

Interest payable. (Assessment year wise)

6. 7.

Total of (5) and (6) Date of payment of tax and interest referred to in (7)