Appendix IV- Intimation for Withdrawal under sub-rule (3) of rule 11UF of the Income- tax Rules, 1962

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..... p;….. …………………………………….. Sir/Madam, I………………………………..(name in block letters) son/ daughter of ………………… designation ……………..and nati .....

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..... larant has received an order in Form No. 2 dated ____ Pursuant thereto, I confirm that the pending appeals or applications or petitions, arbitration, conciliation, mediation, claims or other proceeding, if any, as referred in Part D, Part F, Part G, Part I and Part M of the undertaking in Form No.1 dated…… have been irrevocably, on a with prejudice basis, withdrawn or discontinued a .....

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..... ________ place ___________on this the ___________day _________of __________month _______,_year __________. Place: …………….. Date: …………….. Signature ……………………………….. Note 1. This information is required to be furnished where the Permanent Accoun .....

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