FORM NO 49B

[See section 203A and rule 114A]

Form of application for allotment of tax deduction and collection account number
under section 203A of the Income-tax Act 1!"1
#o
Assessin$ %fficer &#'S ( #)S*


Assessin$ %fficer )ode &#'S ( #)S*
Area )ode
A% #+pe
,an$e )ode
A% -umber

Sir
.hereas I(/0e am(are liable to deduct(collect tax in accordance 0ith )hapter 12II under the
headin$ 345-
'eduction at source6 or 3445 7 )ollection at source6 of the Income-tax Act 1!"18
And 0hereas no tax deduction account number ( tax collection account or tax deduction account
number
and tax collection account number has to allotted to me(/us8
I(/0e $i9e belo0 the necessar+ particulars:

[;lease refer to the instructions before fillin$ up the form]
1. Name (Fill only one of the columns a to h whicheve is a!!lica"le.#
(a# $ental % &tate 'ovenment(

#ic< the appropriate entr+
)entral =o9ernment >ocal Authorit+ &)entral =o9ernment*
State =o9ernment >ocal Authorit+ &State =o9ernment*
-ame of %ffice
-ame of %r$ani?ation
-ame of 'epartment
-ame of @inistr+
'esi$nation of person
responsible for ma<in$
pa+ment ( collectin$ tax
("# &tatutoy % autonomous "o)ies(
#ic< the appropriate entr+ Statutor+ 4od+ Autonomous 4od+
-ame of %ffice
-ame of %r$ani?ation
'esi$nation of person
responsible for ma<in$
pa+ment ( collectin$ tax
(c# $om!any (&ee Note 1#(
#ic< the appropriate entr+

)entral =o9ernment
)ompan+()orporation
State =o9ernment
)ompan+()orporation
%ther

established under a )entral Act established under a State Act )ompan+
#itle &@(s* &tic< if applicable*
-ame of )ompan+
'esi$nation of person
responsible for ma<in$
pa+ment ( collectin$ tax
()# Banch %*ivision of a com!any(
#ic< the appropriate entr+
)entral =o9ernment
)ompan+()orporation
State =o9ernment
)ompan+()orporation
%ther

established under a )entral Act established under a State Act )ompan+
#itle &@(s* &tic< if applicable*
-ame of )ompan+
-ame of 'i9ision
'esi$nation of person
responsible for ma<in$
pa+ment ( collectin$ tax
(e# +n)ivi)ual % ,in)u -n)ivi)e) family (.ata# (&ee Note /#(
#ic< the appropriate entr+ Indi9idual Aindu Bndi9ided Famil+
#itle &#ic< the appropriate entr+ for indi9idual* Shri Smt5 Cumari
>ast -ame ( Surname
First -ame
@iddle -ame
(f# Banch of +n)ivi)ual Business (&ole !o!ietoshi! concen#% ,in)u -n)ivi)e) Family (.ata#
#ic< the appropriate entr+
4ranch of Indi9idual
4usiness
4ranch of Aindu Bndi9ided Famil+
Indi9idual(Aindu Bndi9ided Famil+ &Carta*
#itle &#ic< the appropriate entr+ for indi9idual* Shri Smt5 Cumari
>ast -ame ( Surname
First -ame
@iddle -ame
-ame(>ocation of 4ranch
(0# Fim % 1ssociation of !esons % association of !esons (tusts# % "o)y of in)ivi)uals % atificial
2ui)ical !eson (&ee Note 3#(
-ame
(h# Banch of Fim%association of !esons%association of !esons (tust#%"o)y of +n)ivi)uals%
atificial 2ui)ical !eson(
Name of fim%association !eson%association of !esons (tust#%"o)y of in)ivi)uals%atificial
2ui)ical !eson(
-ame(>ocation of 4ranch
/. 1))ess
Flat('oor(4loc< -o5
-ame of ;remises (
4uildin$ ( 2illa$e
,oad(Street(>ane(;ost %ffice
Area ( >ocalit+ ( #alu< (
Sub-'i9ision
#o0n ( )it+ ( 'istrict
State ( Bnion #erritor+
;I-
&Indicatin$ ;I- is mandator+*
#elephone -o5 S#' )ode #elephone -o5
e-mail I' a*
b*
3. Nationality (4ic5 the a!!o!iate enty#
Indian
Forei$n
4. 6emanent 1ccount Num"e (61N# (&!ecially wheeve a!!lica"le#
7. 89istin0 4a9 *e)uction 1ccount Num"e (41N#: (if any#
;.
89istin0 4a9 $ollection 1ccount Num"e (4$N#: (if any#
<. *ate (**=MM=>>>>#
- -
Si$ned &Applicant*

?eification
I(.e/ in m+(our/ capacit+ as do here b+ declare that 0hat is stated abo9e is
true to
the best of m+(our <no0led$e and belief5
2erified toda+ the - -
' ' @ @ D D D D
at &Si$nature(>eft #humb Impression of Applicant*

Notes(
1. #his column is applicable onl+ if a sin$le #A- is applied for the 0hole compan+ if separate #A- is
applied for different di9isions(branches please fill details in &d*5
/. For branch of indi9idual business(Aindu undi9ided famil+ please fill details in &f*5
3. For branch of firm(Association %f ;ersons(Association %f ;ersons &#rust* ( 4od+ %f Indi9iduals (
Artificial
Euridical ;erson please fill details in &h*5
4. / 'elete 0hiche9er is inapplicable5