Form No. 64 for Statement of Income Distributed By Venture Capital Company or A Venture Capital Fund. Form No. 64 is relevant only for venture capital companies and venture capital funds which make payments to any person on investments made by person in such companies/ funds. This from is required to be verified and certified by a chartered Accountant / restricted state auditor.
Any income received by a person out of investments made in a venture capital company or venture capital fund shall be chargeable to income-tax in the same manner as if it were the income received by such person had he made investments directly in the venture capital undertaking.
The person responsible for making payment of the income on behalf of a venture capital company or a venture capital fund and the venture capital company or venture capital fund shall furnish, within such time as may be prescribed, to the person receiving such income and to the prescribed income-tax authority, a statement in the prescribed form and verified in the prescribed manner, giving details of the nature of the income paid during the previous year and such other relevant details as may be prescribed.
The income paid by the venture capital company and the venture capital fund shall be deemed to be of the same nature and in the same proportion in the hands of the person receiving such income as it had been received by, or had accrued or arisen to, the venture capital company or the venture capital fund, as the case may be, during the previous year.
FORM NO. 64
[See rule 12C]
Statement of income distributed by Venture Capital Company or a Venture Capital
Fund to be furnished under section 115U of the Income-tax Act, 1961
1. Name of the Venture Capital Company or Venture Capital Fund and the address of registered office
2. Permanent Account Number
3. Previous year ending
4. Name and address of the Directors of the Venture Capital Company/trustees of the Venture Capital Fund
5. Total income under all heads received from the investments in Venture Capital Undertakings (6+8+10+12)
6. Total income received from the investments in Venture Capital Undertakings under the head ‘Long-term Capital Gains’
7. Proportion of (6 to 5)
8. Total income received from the investments in Venture Capital Undertakings under the head ‘Short-term Capital Gains’
9. Proportion of (8 to 5)
10. Total Dividend income received from the investments in Venture Capital Undertakings
11. Proportion of (10 to 5)
12. Other income (such as interest etc.) received from the investments in Venture Capital Undertakings
13. Proportion of (12 to 5)
14. Details of persons receiving income from the Venture Capital Company or the Venture Capital Fund in the following format:—
Circle/ Ward/ Special Range where assessed to Income-tax
Total amount paid
Amount paid under ‘Long Term Capital Gains’
Amount paid under ‘Short Term Capital Gains’
Amount paid as ‘dividend’
Other Income such as interest etc. paid
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[Column 6× Sl. No. 9]
[Column 6× Sl. No. 11]
[Column 6× Sl. No. 13]
Enclose a copy of the Certificate of Registration under the Securities and Exchange Board of India Act, 1992.
Enclose a copy of the Venture Capital Fund deed in case of Venture Capital Fund registered under the provisions of the Registration Act, 1908.
Enclose audited accounts including balance sheet, annual report, if any, with certified copies of income and appropriation towards distribution of income.
(Name in full and in block letters) son/daughter/wife of
do hereby solemnly declare that to the best of my knowledge and belief what is stated above and in the Annexure(s), including the documents accompanying such Annexure(s), is correct and complete. I further declare that I am furnishing such statement in my capacity as
(designation) and that I am competent to furnish this statement and verify it.
Verified today the
have examined the books of account and other documents showing the particulars of income earned and the income distributed to the investors by the
(name of the Venture Capital Company or the Venture Capital Fund) for the previous year ending
2. I/We declare that the above particulars are true and correct to the best of my/our knowledge and belief.
|(Signature with name of the Accountant)|