Annexure a Gazetted Officer Word Format

Annexure-A Certifcate to be used by a member o parliament/Member o Legislative Assembly/  Municipal Councillor or Gazetted ocer under sub-rule (! o rule "" o t#e income-ta$ %ules&"')!  A$ same  p#otograp#  p#otograp# as a$ed on A. application

orm

(*o be attested by issuing aut# aut#or orit ity y +it# +it# #is/ #is/#e #er  r  signature , rubber stamp appe appear arin ing g #al #al on t#e t#e cert certif ifca cate te and and #al #al on  p#otograp#!  p#otograp#!

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 PA card by the Income!ta" #epartment to him/her.

Name Father's Name (Even in case of  married ladies Father's Name is to be provided Date of Birth Residence Address (if applicant has resided at more than one place during last one ear then all such address !ith dates should be mentioned "#ce Address $revious Name (in case of change in name% Details of issues of certi&cate $%ce address with location $%ce Seal #ate) Place)

&Signature' (ull ame) #esignation) #epartment/$rganisation *onstituency)

Identity card o)  +elephone ,obile