Verification Certificate

[Certificate under provisions of rule 114(4) of Income Tax Rules, 1962]

 

(Affix same photograph as affixed on PAN application form)

 

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

Son/Daughter of  .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. and whose personal particulars, as given below, are correct to the best of my knowledge & belief. I recommend issue of PAN card by Income Tax Department 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 year than all such address with dates should be mentioned).
Office Address
Previous name (In case of change in name)

Details of issuer of certificate -

Full Name :

Designation :

Department/Organization :

Office address with location :

Identity Card No. :

(Enclose a photocopy of I-Card)

Telephone/Mobile No. :

Verification certificate confirming identity and recommending PAN issuance upon attested photograph, issuer declaration, and contact details. Verification certificate under rule 114(4) certifies an applicant's identity and residence and recommends PAN issuance; the issuer must affix and attest the same photograph as on the PAN application, sign and stamp so the stamp and signature overlap the photograph and certificate, and provide issuer particulars-name, designation, organisation, office address, identity card number (with photocopy), contact number-together with applicant details including name, parentage, date of birth, addresses and previous name if any.