FORM NO. 60 [See second proviso to rule 114B] Form of declaration to e filed !

a person "#o does not #ave a permanent account num er and "#o enters into an! transaction specified in rule 114B 1. Full name and address of t#e declarant $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ %. &articulars of transaction $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ ' (mount of t#e transaction $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 4. (re !ou assessed to ta) * +es ,No -. .f !es/ 0i1 2etails of 3ard, 4ircle, Ran5e "#ere t#e last return of income "as filed* 0ii1 Reasons for not #avin5 permanent account num er* 6. 2etails of t#e document ein5 produced in support of address in column 011 6erification ./$$$$$$$$$$$$$$$$$ do #ere ! declare t#at "#at is stated a ove is true to t#e est of m! 7no"led5e and elief. 6erified toda!/ t#e $$$$$$$$$$$$$ da! of $$$$$$$$$$$$$$$$$ 2ate 8 $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$ &lace 8 $$$$$$$$$$$$$$$$ Si5nature of t#e declarant .nstructions 8 2ocuments "#ic# can e produced in support of t#e address are 89 0a1 Ration 4ard 0 1 &assport 0c1 2rivin5 licence 0d1 .dentit! 4ard issued ! an! institution 0e1 4op! of t#e electricit! ill or telep#one ill s#o"in5 residential address 0f1 (n! document or communication issued ! an! aut#orit! of t#e 4entral :overnment/ State :overnment or local odies s#o"in5 residential address 051 (n! ot#er documentar! evidence in support of #is address 5iven in t#e declaration.