Appendix IV- Intimation for Withdrawal under sub-rule (3) of rule 11UF of the Income- tax Rules, 1962

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..... ed passport number . (hereinafter referred to as signatory ) having Permanent Account Number/Aadhaar Number (see Note 1) on behalf of .. (name of the declarant) having Permanent Account Number / Aadhaar number / Tax Deduction Account Number (see Note 2) .. and being duly authorised and competent to represent the declarant in this regard pursuant to Board Resolution and legal authorisation (see Not .....

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..... f this intimation are true to the best of my knowledge and belief. No part of the intimation is false and nothing has been concealed or misstated therein. Verified at__________ place ___________on this the ___________day _________of __________month _______,_year __________. Place: .. Date: .. Signature .. Note 1. This information is required to be furnished where the Permanent Account Number or Aa .....

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