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Annexure -B

(Certificate to be used by a Employer on the letter head of the Organisation / institution under
sub-rule (4) of rule 114 of the Income-tax ules! 1"#$)
( %o be attested by issuing authority &ith his/her
signature ' rubber stamp appearing half on
the photograph and half on the
certificate)
It is hereby certified that Sh./Smt/Kum ...
son/daughter of .. ....... is employed with us since .. .
He/She is presently working at the following address of the organisation:-
Office Address

he residential address of the applicant as !erified by us is gi!en below:


Residential Address

.
.
"egistration #umber of the $ompany/Institution etc.
%&# of the $ompany/Institution:..
Details of the Individual issuing the certificate
'ull #ame:
(esignation:
%&# of the Indi!idual:
)ffice address with location:
elephone: *Signature+
,obile: )ffice Seal
(ate:
%lace:
((ffix same
photograph as
affixed on )(*
application
form

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