Certificate under section 222 or 223 of the Income-tax Act, 1961

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....p;……………………... To ………………………………... ………………………………... (GIR/PAN) ………………………………... …&he....

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....………………………. [name of the place], for the recovery of the sum of Rs. ……………………………… details of which are given on the reverse [and the said Tax Recovery Officer has sent a certified copy of the said certificate to the undersigned under section 223(2) of the....