Scribd
Upload
2K views1 page

Annexure-A (Pan Verification Form)

This document is a certificate template for Members of Parliament, Members of Legislative Assembly, Municipal Councillors, or Gazetted Officers to certify personal details of an individual applying for a PAN card. It requires the issuer to provide their signature, office details, and personal particulars of the applicant. The certificate must include a photograph and be attested by the issuing authority.

Uploaded by

mdr969987
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
2K views1 page

Annexure-A (Pan Verification Form)

This document is a certificate template for Members of Parliament, Members of Legislative Assembly, Municipal Councillors, or Gazetted Officers to certify personal details of an individual applying for a PAN card. It requires the issuer to provide their signature, office details, and personal particulars of the applicant. The certificate must include a photograph and be attested by the issuing authority.

Uploaded by

mdr969987
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

Annexure -A

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


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

(AfJix same photograph as


alJixed on PAN
application form

(To be attested by issuing authority wilh his/her


signalure & rubber stamp appearing half on the
photograph and half on lhe ceniJicate)

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


son/daughter of ......and hisiher personal particulars as given below
are coffect to the best of my knowledge and belief. I recommend issue of PAN card by the
Income-tax Department to him/her.

Name
Father's Name
(even in case of married ladies father's
name is to be orovided)
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 certilicate

(Signature)
Office address with location Full Name:
Designation:
Office Seal Department/Organisation/Constituency:

Date:
Place:
lf,:'i::'Jl;il1"il:;,.,,.,
Telephone:
Mobile:

Page 21 of24

You might also like