Form for furnishing the details under section 230(1A) of the Income-tax Act, 1961

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..... n (1A) of section 230: 1. Full Name (in Block letters) : ........................................ 2. Present Address : ........................................ 3. Permanent Address : ....................................... 4. Name of *father/husband : ............................... .....

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..... ssport No./Emergency Certificate No. : .............................................. (a) Issued on (date) ........................ (b) From (place) ............................. I declare that to the best of my knowledge and belief, the information furnished is correct and truly stated. Place: ........................ Date: ......................... Yours fait .....

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..... tax Act, 1961. ............................................................... (Signature of the person giving the certificate) .............................................................. Name (in Block letters) ............................................................. Address Verification I .............................................. do .....

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