Appendix-4

-------------------------------------------------------------------------------------- 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 :............................. 5A)PAN Number :............................ 6) Details of Fee :Amount Rs. ................. Bank receipt / .............. DD No.& date Issued by .................. DECLARATION ----------- 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: ................. ------------------------------------------------------------------------------------ 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.