INCOME TAX DEPARTMENT

NATIONAL MASCOT DESIGN CONTEST 2012

SUBMISSION FORM

1. First name.Middle name...

Last name...
2. Fathers / Guardians....................................................................................................
name
3. Address..
PhoneFax..E-mail..
4. Permanent address..
5. Date of Birth (DD-MM-YYYY) ... Qualification
6. Place of Birth...Citizenship..
7. Professional qualifications (if any): .

DECLARATION
I hereby declare that:
1. I have gone through the Guidelines / Criteria for Selection & Terms and Conditions of the
National Mascot Design Contest 2012 and I will abide by them;
2. The mascot design submitted by me is my original work and is not created with any resemblance
or influence of any other mascot design;
3. The design I present is my own creation and is free from any sort of liability/litigation and I shall
be liable in case of any dispute in this regard;
4. Income Tax Department will be free to use this Mascot in any of its communication including
advertising, website or other media;
5. After the submission of my entry, I shall not present a copy or reproduction or recreation of my
design for any other contest or usage;
6. The design I submit shall be the property of the Income Tax Department and I shall have no
control or right over its usage.

PlaceSignature......
Date. Name.

Neatly fill this Submission Form and send it with your entry. Entry without Submission Form
will not be accepted.