I, (*Son/Wife/Principalofficerof) ,Herebyauthorisethecentral

FormNo.10FC

[Seerule21AC]

Authorisationforclaimingdeductioninrespectof

anypaymentmadetoanyfinancialinstitution

locatedinanotifiedjurisdictionalarea

ThePrincipalOfficer,

[Nameandaddressoffinancialinstitution]

------

Sir,

I,------(*son/wife/principalofficerof)------,herebyauthorisetheCentral

BoardofDirectTaxesintheMinistryofFinance,GovernmentofIndiaortheJointSecretary(ForeignTaxTax

Research)–IorJointSecretary(ForeignTaxTaxResearch)–II,CentralBoardofDirectTaxes,asthecasemaybe,

actingonbehalfofCentralBoardofDirectTaxestoobtaintheinformationandrecordsrelatingtomy/ouraccount

maintainedwith------(nameandaddressofthefinancialinstitution)fortheperiodasmay

bespecifiedinthenoticeinwritingwhichmaybeissuedbytheCentralBoardofDirecttaxesortheabovementioned

Income–taxauthorityactingonbehalfoftheCentralBoardofDirectTaxes

Withthisauthorisation,Iherebywaiveallprotectionsprovidedunderanylaw,bywhatevernamecalled,forthetime

beinginforceincludingbutnotlimitedtothelawrelatingtodataprotection,privacyorbankingsecrecy.

Iunderstandthat“records”encompassesalldocumentsthatasanaccountholderorasacustomerIamentitledto

obtainon*myownbehalf/onbehalfof#------,including:

(a)documentsidentifyingtheaccountholder,thebeneficialownerand/orauthorisedpersons;

(b)accountopeningdocuments;

(c)correspondencebetweenthebankandthecustomerorbeneficialownerorthirdpartiesinrelationtothe

account;

(d)accountstatementsandstatementsofassets.

Theauthorisationisirrevocable.

IalsoconfirmthatIamawareofalltheconsequencesofthisauthorisation.

Place------

Signature

Date------

Designation

------

Address

------

PermanentAccountNumber

Copyto:

[NameanddesignationoftheAssessingofficer]

Notes:

1.*deletewhicheverisnotapplicable.

2.#Heregivenameofthecompany,firmetc.whichisthebeneficialowneroftheaccountmaintainedwiththe financialinstitution.”.

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