Verification Certificate (Certificate under provisions of rule 114(4) of Income Tax Rules, 1962) (Aloe same Photograph as ffxed on PAN. ‘application | fom) (To be atestes by issuing authority with is /her signature & rubber stamp appearing halt ‘on the photograph and haf onthe certficate) hereby certify that | know Sh./Smt/Kum, Son/Daughier of, and whose personal particulars, as given below, are correct to the best of my knowledge & belief. | recommend issue of PAN card by Income Tax Department to him/her. Name “T Father's Name (ven In case of marie Iosies father's name sto be prviced) Date of Birth Residence Address {fan coe place dug ist on San an fost adress war es | Suse menione | | Office Address i ~ ~ Previous name incase ofchange n name) ils of issuer of certificate - Designation: Department /Organization Office address with location Identity Card No. (Enclose a photocopy of I-Card) Telephone/Mobile No. Date: (Signature) Place: Office Seal