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FORM NO. 31

[See Rule 42]

APPLICATION FOR A CERTIFICATE UNDER SECTION 230(1) OF

THE INCOME-TAX ACT, 1961

To,

The Assessing Officer,

Foreign Section

Sir,

I request that a Tax Clearance Certificate/an Exemption Certificate be granted to me. I give below the necessary particulars:

1.	Full name of applicant (in block letters)
1A.	Present address
1B.	Permanent address
2.	Name of father (or husband)
3.	Domicile and nationality
4.	Nature of business or profession, etc., in India
5.	Name of Income-tax Circle in which assessed and the G.I.R.No. (if known)
6.	Whether exemption is claimed under any section of the Act? If so, which
7.	Place(s) at which the business or profession is/was carried on
8.	Date of arrival in India (when were the previous visits made and what were the periods of stay in each case)
9.	Destination of journey
10.	Designation of the Assessing Officer, if any, who made the last assessment on the applicant
11.	Probable date of departure
12.	Mode of travel (by air/sea/land*)
13.	Date of intended return, if any
14.	Passport No./Emergency Certificate No.
	issued on (date)
	from (place and country)

I declare that to the best of my knowledge and belief, the information furnished in the application is correct, complete and is truly stated.

# Authorisation form obtained from the Assessing Officer is enclosed herewith.

Place:		Yours faithfully,
Date:		Applicant
* Delete the inappropriate words.
# This applies only if the applicant is a person domiciled in India or is a person which has been assessed by an Assessing Officer anywhere in India.