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Note: Please see para 4.21 of this Handbook
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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 :.............................
5A)PAN Number :............................
6) Details of Fee :Amount Rs. .................
Bank receipt / ..............
DD No.& date
Issued by ..................
DECLARATION
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i) I am the Proprietor / Partner / Director of the firm.
ii) I hereby declare that Shri.................... in whose favour
identity card is to be issued is the authorised employeee 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 Applicant:..............
Name: .................
Designation: .................
Official Address: .................
.................
Tele.No.:
Residential Address: .................
Place : .................
Date : E. Mail address: .................
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Documents to be enclosed with the application form:
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1. Bank Receipt (in duplicate) / Demand Draft evidencing payment of application
fee in terms of Appendix-34.
2. Two passport size photographs of the person in whose favour identity card is to
be issued.
3. Copy of RCMC duly attested by Partner / Propriator / Director.