Whereas a certificate bearing Serial Number.......... dated............. had been forwarded by the Tax Recovery Officer, .................[name of the place], for the recovery of the sum of Rs. ............ details of which are given on the reverse and the said Tax Recovery Officer has sent a certified copy of the said certificate to the undersigned under section 33(2) of the Black Money (Undisclosed Foreign Income and Assets) and Imposition of Tax Act, 2015 specifying a sum of Rs. .............. which is to be recovered from you.
Chapter I — Full Text