APPENDIX - 4
FORM OF APPLICATION OF IDENTITY CARD
Note: Please see
para 4.21 of this Handbook
FOR OFFICE USE
File No.: ................................ Date: .........
........................................................... |
Photograph duly
attested by
Proprietor/
Partner /
Director | |
1) Name of the person :........................................
(in whose favour Identity Card
to be issued)
2) Designation of the person :........................................
3) Residential address :........................................
.........................................
4) Name and address of the
applicant firm :........................................
.........................................
5) IEC Number :........................................
6) Details of Fee :Amount Rs. .......................
Bank receipt / ...................
DD No.& date
Issued by ........................
DECLARATION
- I am the Proprietor / Partner / Director of the firm.
- I hereby declare that Shri.................... in whose favour
identity card is to be issued is the authorised employee of
the firm.
- 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 Applicant:..............
Name: .................
Designation: .................
Official Address: .................
.................
Tele.No.: ..................
Residential Address: .................
Place : ................
Date : E. Mail address: ...................
Documents to be enclosed with the application form:
- Bank Receipt (in duplicate) / Demand Draft evidencing payment of application
fee in terms of Appendix-34.
- Two passport size photographs of the person in whose favour identity card is to
be issued.
- Copy of RCMC duly attested by Partner / Propriator / Director.