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