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Information regarding ITR Filing for the AY: ……………….

Code:

1. Name (As in PAN Card): …………………………………………………………………………………………………………

2. DoB (As in PAN Card) : ……………………………….

3. Father’s Name (As in PAN Card): ……………………………………………………………………………………………

4. Permanent Account No (PAN): …………………………………………………………………………………………………

5. Address (Permanent): ……………………………………………………………………………………………………………

……………………………………………………………………………………………………………

6. Address (Postal): …………………………………………………………………………………………………………….

…………………………………………………………………………………………………………….

7. Bank A/c No (With Name of Bank): ……………………………………………………………………………………….

8. IFSC Code of Bank A/c: …………………………………………………………………………………………………………..

9. MICR Code of Bank A/c: ………………………………………………………………………………………………………..

10. Email-Id: ………………………………………………………………………………………………………………………………….

11. Contact No: …………………………………………………………………………………………………………………………..

12. Organization Name: ……………………………………………………………………………………………………………..

13. Organization Address: …………………………………………………………………………………………………………..

…………………………………………………………………………………………………………..

Encl: I) ITR V of Last AY.


II) Copy of PAN Card (Self Attested)

Declaration

I …………………………………………………………………………….. do hereby declare that the particulars of the


information given above are true to the best of my knowledge and belief and for the use of filing of
“Income Tax Return” of the corresponding Assessment Year.

Date: ……………………………..

Place: (Signature)