APPENDIX - 5
FORM OF APPLICATION OF IDENTITY CARD
Note: Please see paragraph 2.16 of this Handbook
FOR OFFICIAL USE
File No.:...................................... Date:...........................
.................................................................................... |
| Photograph duly attested by Proprietor/ Partner/ Director |
|---|
|
| 1) | Name of the person
(in whose favour Identity
Card is to be issued)
| |
| 2) | Designation of the person | :.............................
|
| 3) | IEC Number | :.............................
|
| 4) | Details of Fee | :Bank receipt/ ....................
DD No.& date
Amount Rs. .................
Name of the Bank and
Branch of issue
|
DECLARATION
i) I am the Proprietor/Partner/Director of the firm/company.
ii) I hereby declare that Shri .................... in whose favour identity card is to be issued is the authorised employee of the firm.
iii) I further undertake that the document(s) /Licence(s) may be handed over to the Identity Card holder at the sole risk and responsibility of the firm.
( )
Signature of the proprietor/ partner/ director
Name: .................
Designation: .................
Official Address: .................
.................
Tele.No.:..................
Residential Address: .................
..................
E.Mail Address : .. .. .. .. .. ..
Place :
Date :
Documents to be enclosed with the application form:
1. Bank Receipt (in duplicate)/Demand Draft evidencing payment of application fee in terms of Appendix-29.
2. Two passport size photographs of the person in whose favour identity card is to be issued.
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