Indent

Indent for requisition of PAN BULK VERIFICATION service to UTITSL Sir, I/We would like to register for the Online PAN Verification service offered by UTITSL. I/We give below necessary particulars: Title Shri Smt. Last Name/Surname:

Kumari

M/s First Name:

Middle Name:

O. Office Address:(Name of office) Name of organisation Address Line 1 Address Line 2 Address Line 3 Address Line 4 Town/City/District State/Union Territory Pin(Indicating PIN is mandatory) Telephone No. e-mail ID Digital signature Key* * Class II Digital Signature can be obtained from any licensed CA of GOI. Services opted for : (Put a check mark against selected options) ONLINE PAN VERIFICATION (Available on registration , upto 750 Rs.12000/- p.a. PAN numbers per user per day) FILE UPLOAD Facility

Rs.12000/- p.a. + initial Rs.5000/-

(Additional minimum payment of Rs.5000/- in advance. Limit of 200 PAN numbers per file. Deduction of Rs.75/- per file download will be effected from the payment of Rs.5000/-) Software based PAN verification facility (Additional minimum payment of Rs.5000/- in advance. Deduction of Rs.12000/- p.a. + initial Rs.5000/37.5 paisa per PAN number queried, over and above 750 PAN numbers queried per user per day. ) Net Amount Service Tax @12.36% Gross Amount 1. Payment Details Demand Draft/Pay Order(in favour of 'UTITSL-PAN Bulk Verification ' ) payable at Mumbai. Select Payment Mode Demand Draft Pay Order Demand Draft number ___________________ Dated ______________ Total Amount- ________________- and Service [email protected]% Drawn On __________________________ Bank and Branch, payable at Mumbai. OR Pay Order number _______________Dated _______________ Total Amount-_________________/- and Service [email protected]% Drawn On _______________________________Bank, Branch, payable at Mumbai.

Any additional specific requirements of the user: (The requirement and commercials proposed will be discussed with ITD and if approved, will be taken up by UTITSL )

Signature (attested)