Appendix 20 A

Form of Application of Identity Card

 

Photograph duly Proprietor/
Partner/
Director attested by

1)    Name of the person            :     .............................

      (in whose favour Identity

      Card is to be issued)

2)    Designation of the person    :     .............................

3)    IEC Number                       :     .............................

4)    Details of Fee                     :

      Bank receipt/ ..............

      DD No.& date

      Amount Rs. ...

      Name of the Bank

      Branch of issue

Declaration

i)      I am the Proprietor/Partner/Director of the firm/company.

ii)     I hereby declare that Shri .................... in whose favour identity card is to be issued is the authorised employee 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 proprietor/ partner/ director

                                                                                            Name

                                                                                            Designation

                                                                                            Official Address

                                                                                            Tele.No

                                                                                            Residential Address:

                                                                                            E.Mail Address

Place

Date

Documents to be enclosed with the application form

1.    Bank Receipt (in duplicate)/Demand Draft evidencing payment of application fee in terms of Appendix-29.

2.    Two passport size photographs of the person in whose favour identity card is to be issued.