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Orwarded to the Chief Commissioner or Commissioner of Income-tax, ......................... . Place ....................... .......... . Signature of the person responsible for paying * interest other than interest on securities / income in respect of units Notes: 1. Give complete postal address. 2. The declaration should be furnished in duplicate. 3. *Delete whichever is not applicable. 4. **Indicate the capacity in which the declaration is f.

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