(Signature of Company Secretary or Director or Authorized Signatory) Name of the Company Secretary or Director or Authorized Signatory DECLARATION FORM Annexure A List of Authorized Person (s), who is/are not covered in definition of a as defined in Section 2(v) of The Aadhaar “resident” (targeted delivery of financial and other subsidies, benefits and services) Act, 2016 (“Aadhaar Act, 2016”) and thus, he/she/they are not eligible to obtain an Aadhaar number. BANK / LOAN / CORPORATE CARD RELATIONSHIP ACCOUNT NUMBER: _______________________________________________________ PAN Details Passport Details / Driving License (Please indicate Yes / No / Not Details Applicable (NA) against each (If PAN Number / Form 60 is not Authorized Person) submitted) S. Name of Authorized Person Passport No. (Please type/write in BLOCK Letters) Number / Country Date of PAN Number Form 60 Driving of Expiry License Issuance Number 1 2 3 4 5 6
(Signature of Company Secretary or Director or Authorized Signatory) Name of the Company Secretary or Director or Authorized Signatory DECLARATION FORM Annexure A List of Authorized Person (s), who is/are not covered in definition of a “resident” as defined in Section 2(v) of The Aadhaar (targeted delivery of financial and other subsidies, benefits and services) Act, 2016 (“Aadhaar Act, 2016”) and thus, he/she/they are not eligible to obtain an Aadhaar number. BANK / LOAN / CORPORATE CARD RELATIONSHIP ACCOUNT NUMBER: _______________________________________________________ S. No. Name of Authorized Person (Please type/write in BLOCK Letters) PAN Details (Please indicate Yes / No / Not Applicable (NA) against each Authorized Person) Passport Details / Driving License Details (If PAN Number / Form 60 is not submitted) PAN Number Form 60 Passport Number / Driving License Number Country of Issuance Date of Expiry 1 2 3 4 5 6
Declaration-Form.docx