Nestle India : Format for declaration for claiming benefits under DTAA. (pdf, 273Kb)

FORMAT FOR DECLARATION FOR CLAIMING BENEFITS UNDER DTAA

	Date:
To,
Nestlé India Limited
100 / 101, World Trade Centre, Barakhamba Lane,
New Delhi - 110 001	Email: [e-mail]

Subject: Declaration for eligibility to claim benefit under Double Taxation Agreement between

Government of India and Government of ("DTAA"), as modified by Multilateral Instrument ("MLI"), if applicable

With reference to above, I/We wish to declare as below:
1. I / We,	, having
permanent account number (PAN) under the Indian Income tax Act,
>, and holding		number

of shares of the Company under demat account number/ folio number …………….. as on the Record

date, am / are a tax resident of in terms of Article 4 of the DTAA

as modified by MLI (if applicable) and do not qualify as a 'resident' of India under section 6 of the Indian Income-tax Act, 1961 ("the IT Act").A copy of the valid tax residency certificate for ,which is valid as on the Record Date, is attached herewith.

1. I/We am/are eligible to be governed by the provisions of the DTAA as modified by MLI (if applicable), in respect of the dividend income and meet all the necessary conditions to claim treaty rate.
2. I/We am/are the legal and beneficial owner of the dividend income to be received from the Company.
3. I/We do not have a Permanent Establishment ("PE") in India in terms of Article 5 of the DTAA as modified by MLI (if applicable) or a fixed base in India and the amounts paid/payable to us, in any case, are not attributable to the PE or fixed base, if any, which may have got constituted otherwise.
4. I/We do not have a PE in a third country and the amounts paid/payable to us, in any case, are not attributable to a PE in third jurisdiction, if any, which may have got constituted otherwise.
5. I/We do not have a Business Connection in India according to the provision of section 9(1)(i) of the Act and the amounts paid/payable to us, in any case, are not attributable to business operations, if any, carried out in India.
6. I/We confirm that my affairs/affairs of___________________________ were arranged such that the main purpose or the principal purpose thereof was not to obtain tax benefits available under the applicable tax treaty.
7. Further, our claim for relief under the tax treaty is not restricted by application of Limitation of Benefit clause, if any, thereunder.

I/We hereby certify that the declarations made above are true and bonafide. In case in future, any of the declarations made above undergo a change, we undertake to promptly intimate you in writing of the said event. You may consider the above representations as subsisting unless intimated otherwise.

I/we in the event of any income tax demand (including interest, penalty, etc.) arising from any misrepresentation, inaccuracy or omission of information provided by me, I will be responsible to pay and indemnify such income tax demand (including interest, penalty, etc.) and provide the Company with all information / documents that may be necessary and co-operate in any proceedings before any income tax / appellate authority.

For

Authorised Signatory

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