FORM NO. 27G
[See rule 37H]
Certificate under sub-section (9) of section 206C of the Income-tax Act, 1961, relating to collection of tax at source

Certificate No……………………….                           
 * To                                                                                            Income-tax Office,
                                                                                                    Date……………
I hereby authorise you to debit the amount payable by M/s………….(Name of the buyer) to his account or to receive, as the case may be, such amount from the said buyer on account of sale of……….[Specify the nature of goods referred to in the Table in sub-section (1) of section 206C] the particulars of  which are given in the Schedule below, after collecting income-tax at the rate of…………per cent of such amount. 
2. This certificate shall remain in force for the assessment year……….unless it is cancelled by me under intimation to you before the expiry of the said period. 
SCHEDULE

Serial number	Full name and address of the seller	Date of sale with reference number of such sale	Nature and description of the goods sold and details of sale	Amounts expected to be debited/received in pursuance of the sale during the current financial year
1	2	3	4	5

(Seal) 
*Name and address of the person responsible for collecting tax.                  Assessing Officer