Annexure-A

Certificate to be used by a member of parliament/Member of Legislative Assembly/

Municipal Councillor or Gazetted officer under sub-rule (4) of rule 114 of the
income-tax Rules,1962)

Affix same
photograph as
affixed on PAN
application form

(To be attested by issuing

authority with his/her
signature & rubber stamp
appearing half on the
certificate and half on
photograph)

I hereby certify that I know GANGA RAM GARO son of HAR CHAND GARO
and his personal particulars as given below are correct to the best of my knowledge
and belief. I recommend issue of PAN card by the Income-tax Department to him.
Name GANGA RAM GARO
Father's Name (Even in case of HAR CHAND GARO
married ladies Father's Name is to
be provided)
Date of Birth 04/09/1948
Residence Address (if applicant 4- BRIJ SADAN, GOVIND NAGAR,
has resided at more than one SECTOR NO 13, UDAIPUR -313001
place during last one year then all (RAJASTHAN)
such address with dates should be
mentioned)
Previous Name (in case of GANGA RAM GARG
change in name)
Previous Fathers Name (in HAR CHAND GARG
case of change in Fathers name)

Details of issues of certificate

Full Name: MONIKA GARG

Designation: DEPUTY DIRECTOR (R.Ac.S)

Department/Organization: FINANCE DEPARTMENT (GOVERNMENT OF RAJASTHAN)

Office address with location: H.C.M. RIPA, RANI ROAD, UDAIPUR

Identity card No: A-457

(Enclose a Photocopy of I-Card)

Telephone/Mobile: 9460079292

Date: 27-04-2017
Place: UDAIPUR
 (Signature)

Office Seal