Before the Assessing Officer, Ward No ……….. ……………………

Circle …………….

In the matter of assessment proceeding of Shri……………………..PAN
…………………………………

Affidavit of…………………… aged about …………………….years, son of
……………….resident of…….…………

I,………………………above named deponent, do solemnly affirm and state on oath as under:

1 . That I am the assessee in the above noted proceedings and as such fully conversant with the facts deposed to below.
2. That I am a doctor carrying on the business of practice in medicine at ……………………,
since …………………….……………
3. That report of the Income-tax Inspector that the chamber in which I am practising and the house, in which I am staying belongs to me, is absolutely false.
4. That Shri …………………………..son of resident of ……………………………is the owner of the chamber, in which I am practising and I have taken the said chamber on lease from him and I am paying Rs. …………………….…p. m. as lease rent to its owner. The copy of the lease deed and receipt of lease rent for the month of ………20………..is enclosed and collectively marked as Annexures 1.
5 That the House No ………….. at…………..in which I reside was constructed by my father-in-law late Shri who was a reputed doctor of and was earning from his private practice to the tune of Rs ……… per year, and he was income-tax assessee with PAN ………….with…………………..Ward, Circle…………………………..
After his death, my wife being his only daughter inherited the said house in terms of his will dated and she is now the owner of the said house in terms of the will of late Dr ………………..who has clearly stated that Smt will be the absolute owner of the said house.
6. That the returns filed by me are correct and the Income-tax Inspector has made wrong report about my income and assets.
7. That the assessment be made on my income, as shown in the return filed by me.

I . ……………………….the above named deponent, do hereby verify that the contents of paras 1 to 6 of this affidavit are true to my knowledge and that the contents of paragraph 7 are my submission to this Honourable Assessing Officer.

Verified at……………………. this…………………the day of ………………………….

Date…………… Deponent