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Rtain receipts without deduction of tax. PART - I 2 PAN of the Assessee: 3 Age : 4 Assessment Year(for which declaration is being made): 1 Name of Assessee (Declarant) : 2014-15 5 Flat / Door / Block No. : 6 Name of Premises : 7 Assessed in which Ward / Circle 8 Road / Street / Lane : 9 Area / Locality : 10 AO Code (whom assessed last time) : Area Code 11 Town / City / District : Range Code AO No. 12 State : 14 Last Assessment Year in which assessed : 13 PIN 15 Email.

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