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FORM DB

[See rule 4C]


Declaration under section 18C(1) of the Wealth-tax Act, 1957 to be made by an assessee claiming that
identical question of law is pending before the High Court or the Supreme Court
I, ...............................................................................................................................................................,. son/
[Name in full in block letters]
daughter/wife of shri .............................................................. being the* .........................................................
of ...................................................do hereby declare :-
1. That the following question(s) of law **is/are pending in **my case/in the case
of ................................ .......................................................................... before the **High Court/Supreme Court
on a reference under section 27
Supreme Court on an appeal under section 29 in respect of the assessment year ....................... **A copy of the
statement of the case and the question(s) of law referred to the High Court/Supreme Court is/are enclosed.
**A copy of the judgement of the High Court and grounds of appeal to the Supreme Court is/are enclosed.
2. That the said question(s) of law **is/are identical with the question(s) of law arising in **my case/in the case of
...................................................... in respect of the assessment year ........................... which is pending before
*** ............................................................
3. That if the *** ................................... agrees to apply to the case referred to in paragraph 1 above. **I/the
assessee mentioned in paragraphs 1 and 2 above, shall not raise the said question(s) of law in the case referred
to in paragraph 2 above in appeal before any appellate authority or for a reference before the High Court or the
Supreme Court under section 27 or in appeal before the Supreme Court under section 29.
.....................................................................
Signature of the declarant
....................................................................
Permanent Account No.
.....................................................................
Address of the assessee
Verification
I, ......................, do hereby declare that to the best of my knowledge and belief what is stated above is correct,
complete and is truly stated.
I, further declare that I am making the declaration in my capacity as .......................... and that I am competent to
make this declaration and verify it.
Verified today, the ......................... day of ............... 19 ................
Place ........................... ......................................................................
Signature of the declarant
Notes :
1. The declaration should be in duplicate when it is furnished to the Deputy Commissioner (Appeals) or the
Commissioner (Appeals) and in triplicate when it is furnished to the Appellate Tribunal.
2. *Mention the capacity in which the declaration and verification is made.
3. **Delete whichever is not applicable.
4. ***Mention the designation of the officer or authority to whom or to which the declaration is furnished.
5. Give complete postal address. Where the declarant is not the assessee, also give the complete postal address of
the assessee.

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