The individuals mentioned in the last paragraph of 1 of I of article 117 quater and in the last paragraph of I of article 125 A formulate, under their responsibility, their request for exemption from the levies provided for in the same I at the latest on 30 November of the year preceding that of the payment of the income mentioned in the said I, by producing, from the persons who ensure the payment, a sworn statement to the effect that their reference tax income as shown on the tax notice drawn up in respect of the income for the penultimate year preceding the payment of the income referred to in the same I is less than the amounts referred to in the last paragraph of 1 of I of article 117 quater and in the last paragraph of I of article 125 A. By way of derogation, taxpayers make their request for exemption from the levy provided for in 2 of II of article 125-0 A and in 2° of b quinquies of 5 of article 158 no later than when the income is received.
The persons who ensure payment of the income mentioned in the first paragraph are required to produce this certificate at the request of the administration.