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Procedure

APPENDIX - 4

Document type
Procedure
Dated

FORM OF APPLICATION OF IDENTITY CARD

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
  1. I am the Proprietor / Partner / Director of the firm.

  2. I hereby declare that Shri.................... in whose favour identity card is to be issued is the authorised employee of the firm.

  3. 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:

  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.

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