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Format of Gazette Certificate 03082012

This document is a certificate that can be issued by certain government officials to verify personal details for a PAN card application. The certificate contains fields for the applicant's name, father's name, date of birth, current and previous residence addresses, previous name if applicable, and details of the issuing authority like their name, designation, office address, identity card number, and contact information. The issuing authority must sign and stamp the certificate, and attach a photograph of the applicant that is also signed and stamped.

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rajikul islam
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9K views1 page

Format of Gazette Certificate 03082012

This document is a certificate that can be issued by certain government officials to verify personal details for a PAN card application. The certificate contains fields for the applicant's name, father's name, date of birth, current and previous residence addresses, previous name if applicable, and details of the issuing authority like their name, designation, office address, identity card number, and contact information. The issuing authority must sign and stamp the certificate, and attach a photograph of the applicant that is also signed and stamped.

Uploaded by

rajikul islam
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Annexure -A

(Certificate to be used by a Member of Parliament/Member of Legislative Assembly / Municipal Councillor or


Gazetted Officer under sub-rule (4) of rule 114 of the Income-tax Rules, 1962)

(Affix same
photograph as
affixed on PAN
application form

(To be attested by issuing authority with


his/her signature & rubber stamp appearing
half on the photograph and half on the
certificate)

I hereby certify that I know Sh./Smt/Kum .


son/daughter of ...and his/her personal particulars as given
below are correct to the best of my knowledge and belief. I recommend issue of PAN
card by the Income-tax Department to him/her.
Name
Fathers Name
(even in case of married ladies fathers
name is to be provided)

Date of Birth
Residence Address
(if applicant has resided at more than
one place during last one year then
all such address with dates should be
mentioned)

Office Address
Previous Name (in case of
change in name)

Details of issuer of certificate

Office address with location


Office Seal
Date :
Place:

(Signature)
Full Name:
Designation:
Department/Organisation/Constituency:
Identity card No:
(Enclose a photocopy of I-card)

Telephone:
Mobile:

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