Form for furnishing the details under section 230(1A) of the Income-tax Act, 1961

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.... 230: 1. Full Name (in Block letters) : ........................................ 2. Present Address : ........................................ 3. Permanent Address : ....................................... 4. Name of *father/husband : ....................................... 5. Nature of business/profession in India : ....................................... 6. *The 1[Permanent Account Number ....

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..... I declare that to the best of my knowledge and belief, the information furnished is correct and truly stated. Place: ........................ Date: ......................... Yours faithfully (Applicant) *Delete whichever is not applicable. ANNEXURE Certificate to be furnished by a person domiciled in India whose total income is not chargeable to income-tax or who is not required to obta....

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............................................. Address Verification I .............................................. do hereby certify that to the best of my knowledge and belief what is stated above is correct and truly stated. Verified today the ...................................... day of Place ................................. ................................................. (Signature of....