2. Have you ever been
known by any other name? |
(Yes/No) |
If yes,
please give other name (no initials please) |
Please
fill as applicable ( Shri / Smt./ Kumari / M/s ) |
Last
Name/Surname
|
First
Name
|
Middle
Name
|
3.
Address |
A. Residential Address |
Flat/Door/Block
No.
|
Name
of Premises/Building/Village
|
Road/Street/Lane/Post
Office
|
Area/Locality/Teluka/Sub-Division
|
Town/City/District
|
State/Union
Territory
|
Pin
|
B. Office
Address |
Flat/Door/Block
No.
|
Name
of Premises/Building/Village
|
Road/Street/Lane/Post
Office
|
Area/Locality/Teluka/Sub-Division
|
Town/City/District
|
State/Union
Territory
|
Pin
|
4.
Email Address
|
5. Status
of the Applicant (Individual/Hindu Undivided
Family/Company/Firm/Association Of Person/Association Of
Persons(Trust)/Body Of Individuals/Local AuthorityArtificial Judicial
Person) |
6. If any
individual, please give Father's Name (no initials please) |
Last
Name/Surname
|
First
Name
|
Middle
Name
|
7. Sex
(For Individual Applicant only) |
(Male/Female) |
8.
Date of (Birth /Incorporation/Agreement/Partnership or Trust
Deeds/Formation Of Body Of Individuals/Association Of Persons) |
9.
Whether citizen of India? (Yes/No) |
10.
Registration Number (In case of Firms, Companies etc.)
|
11.
Source(s) of Income ( Saleries / House Property / Business 0r
Profession /Capital Gains / Income From Other Source(s) ) |
12.
Particulars of Business, if any
HEAD OFFICE |
Name of Office |
|
Flat/Door/Block
No. |
|
Name of
Premises/Building/Village |
|
Road/Street/Lane/Post
Office |
|
Area/Locality/Taluka/Sub-Division |
|
Town/City/District |
|
State/Union
Territory |
|
Pin |
|
|
|
- Tax Deduction Amount No. if any
|
|
|
DD MM
YYYY
|
|
|
BRANCHES
(If required, please add in the given boxes below) |
Name of Branch (No.1) |
|
Flat/Door/Block
No. |
|
Name of
Premises/Building/Village |
|
Road/Street/Lane/Post
Office |
|
Area/Locality/Taluka/Sub-Division |
|
Town/City/District |
|
State/Union
Territory |
|
Pin |
|
|
|
-
Tax Deduction Account No, if any
|
|
|
DD
MM
YYYY
|
13. If Firm/Hindu Undivided
Family/Association of Persons/Body of Individuals/Company, the names,
Addresses etc. of Partners/Members/Directors/ (For information about
more persons, please add separate sheet(s) in the format given below) |
DETAILS OF
PARTNERS/MEMBERS/DIRECTORS |
a) Number of |
(Partners/Members/Directors)
No. |
Please fill as applicable |
(Shri / Smt. / Kumari / M/S) |
b) Full
Name of the first member/partner etc. (no initials please) |
Last Name/Surname |
|
First
Name |
|
Middle
Name |
|
c) Address |
|
Flat /Door/Block
No. |
|
Name
of Premises/Building/Village |
|
Road/Street/Lane/Post
Office |
|
Area/Locality/Taluka/SubDivision |
|
Town/City/District |
|
State/Union
Territory |
|
Pin |
|
|
Last Name/Surname |
|
First Name |
|
Middle
Name |
|
c) Address |
|
Flat /Door/Block No. |
|
Name of
Premises/Building/Village |
|
Road/Street/Lane/Post
Office |
|
Area/Locality/Taluka/SubDivision |
|
Town/City/District |
|
State/Union
Territory |
|
Pin |
|
|
|
14. Full
Name, address of the representative assessable under the Income Tax Act
in respect of the person, whose particulars have been given in column 1
to 13 (Please see Instruction no.14) |
Please fill as
applicable |
(Shri / Smt. / Kumari / M/S) |
Full
Name(no initials please) |
Last Name/Surname |
|
First Name |
|
Middle
Name |
|
Address |
Flat/Door/Block No. |
|
Name of
Premises/Building/Village |
|
Road/Street/Lane/Post
Office |
|
Area/Locality/Taluka/Sub-Division |
|
Town/City/District |
|
State/Union
Territory |
|
Pin |
|
15.(i)
Permanent Account Number, if any allotted earlier* |
(ii) GIR
No., if any allotted earlier |
(iii)
Ward/Circle/Range |
I/We,
, the applicant, do hereby declare that what is stated above is true
to the best of my/our information and belief.
*Applicable in places notified by
the Board under Subsection(4) of Section 139A of the Income Tax Act,
1961. |
Verified today, the |
|
DD MM
YYYY
|