(1)   The application for a certificate under section 51(2) of the Ordinance shall be made in
         the following form:-

Application for a Certificate under section 51(2) of the Income Tax Ordinance, 1984
                                                    (XXXVI of 1984).
To
The Deputy Commissioner of Taxes,
.....................................................
.....................................................

Sir ,
I,.................................................... ...of......................................................... ..do         hereby
declare that to the best of my belief, my total income from interest on securities will amount to
Taka ................................ .. which will be less than the minimum income liable to tax/ liable
to tax   at a rate less than the maximum. Amount of taka ....................................................

I, therefore, request that a certificate may be issued to the person responsible for paying interest   on   securities   particulars of   which are given in the Schedule annexed
                                      
hereto authorising him not to deduct tax / to deduct tax at the rate of -------------------------------------- at the time of payment of such interest.

                                                                                        Signature ...................................... .
                                                                                        Date..............................................                                                                                                    Address.......................................

I hereby declare that I am resident / non-resident---------------- in Bangladesh and that what is stated in this  application is correct.

                                                                                         Yours faithfully,
                                                                                        Signature ...................................... .
                                                                                        Date..............................................                                                                                                    Address.......................................

                                                        Schedule
(1)   Description of securities,
(2)   Number (s) of securities,
(3)   Date (s) of securities,
(4)   Amount (s) of securities,
(5)   Date (s) on which the amount (s) is/are payable

(2)   The certificate under section  51(2) of the Ordinance shall be issued by the Deputy
         Commissioner of Taxes in the following form:

                             Certificate under section 51(2) of the Income Tax Ordinance , 1984.
                                              Office of the Deputy Commissioner of Taxes,
                                                                        .. Circle ...                           .

To
................................................(Designation) ..........................................
Address................................................... .............................................
(of paying authority)

Certified that to the best of my belief, the total income of Mr............................................of ...................................... . recepient of any payment classifiable under the head “ Interest on securities” will be less than the minimum liable to tax / liable to tax at a rate less than the maximum.
    

I, therefore, authorise you not to deduct tax / to deduct tax---------------------- at the rate of ................... .. at the time of payment of such interest to the person named in the certificate until the certificate is cancelled.

                                                                                           Signature .................................. ..
                                                                                           Designation ............................... ..
                                                                                           Date......................................... ..
                                                                                          Circle....................................... ..
                                                                                           Place…………………………