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M/S.

B O S E F I L L I N G S T A T I O N
At M.V. 17, Post: Sikhapally, Ps: & Dist: Malkangiri (ODISHA), Mob: 7894112059
9438082535
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To

DRSH
Indian Oil Corporation Limited
Sambalpur Divisional Office
Ainthapali, kainsir Road, Sambalpur

Kind Attn:

Sub: Declaration against Section 269SU of the Income tax Act, 1961.

Dear Sir/Madam,

This is to confirm that we have gone through the provisions of Section 269SU of the Income tax
Act, 1961 regarding payment through E-modes. I /We do not have net banking facility or any
other E-Mode faculty at the time of payment/for the time being/always. I / We have no option
but to pay by mode other than E-Mode, though you insisted for payment by E-Mode only.

Thanking You,
Yours Sincerely

Sign and stamp

Encl:

1. Copy of Aadhar card


2. Copy of PAN card
3. GST No.
4. Mobile No
5. Address of the company:

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