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Verification Certificate - Certificate under provisions of rule 114(4) of Income Tax Rules, 1962

July 27, 2012
 

Verification Certificate

[Certificate under provisions of rule 114(4) of Income Tax Rules, 1962]

 

 

(Affix same photograph as affixed on PAN application form)

 

 

 

(To be attested by issuing authority with his/her signature & rubber stamp appearing half on the photograph and half on the certificate)

I hereby certify that I know Sh./Smt./Kum .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..

Son/Daughter of  .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. and whose personal particulars, as given below, are correct to the best of my knowledge & belief. I recommend issue of PAN card by Income Tax Department to him/her.

Name

 

Father's Name

(Even in case of married ladies father's name is to be provided)

 

Date of Birth

 

Residence Address

(If applicant has resided at more than one place during last one year than all such address with dates should be mentioned).

 

Office Address

 

Previous name

(In case of change in name)

 

Details of issuer of certificate -

Full Name :

Designation :

Department/Organization :

Office address with location :

Identity Card No. :

(Enclose a photocopy of I-Card)

Telephone/Mobile No. :

Date:

Place:

(Signature)

Office Seal

 
_____________________________________

 

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