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    Declaration Form

    Uploaded by

    himanshu chhabra
    The document is a merchant declaration form for PhonePe Private Limited. It contains the following key information: 1. Deepankar Gope declares that the specimen signature provided will be considered the authenticated signature as the sole authorized signatory for the merchant. 2. The merchant declares their tax registration status under the Income Tax Act, selecting whether they have a TAN number or are not required to deduct/collect tax. 3. The merchant declares their GST registration status, selecting whether they have a GSTIN or no registration is required. 4. Deepankar Gope declares the above facts are true and correct to the best of their knowledge, understanding any incorrect information could result in personal

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    Declaration Form

    Uploaded by

    himanshu chhabra
    712 views1 page
    The document is a merchant declaration form for PhonePe Private Limited. It contains the following key information: 1. Deepankar Gope declares that the specimen signature provided will be considered the authenticated signature as the sole authorized signatory for the merchant. 2. The merchant declares their tax registration status under the Income Tax Act, selecting whether they have a TAN number or are not required to deduct/collect tax. 3. The merchant declares their GST registration status, selecting whether they have a GSTIN or no registration is required. 4. Deepankar Gope declares the above facts are true and correct to the best of their knowledge, understanding any incorrect information could result in personal

    Original Description:

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    Declaration Form (19) (1) (4)

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    The document is a merchant declaration form for PhonePe Private Limited. It contains the following key information: 1. Deepankar Gope declares that the specimen signature provided will be considered the authenticated signature as the sole authorized signatory for the merchant. 2. The merchant declares their tax registration status under the Income Tax Act, selecting whether they have a TAN number or are not required to deduct/collect tax. 3. The merchant declares their GST registration status, selecting whether they have a GSTIN or no registration is required. 4. Deepankar Gope declares the above facts are true and correct to the best of their knowledge, understanding any incorrect information could result in personal

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    712 views1 page

    Declaration Form

    Uploaded by

    himanshu chhabra
    The document is a merchant declaration form for PhonePe Private Limited. It contains the following key information: 1. Deepankar Gope declares that the specimen signature provided will be considered the authenticated signature as the sole authorized signatory for the merchant. 2. The merchant declares their tax registration status under the Income Tax Act, selecting whether they have a TAN number or are not required to deduct/collect tax. 3. The merchant declares their GST registration status, selecting whether they have a GSTIN or no registration is required. 4. Deepankar Gope declares the above facts are true and correct to the best of their knowledge, understanding any incorrect information could result in personal

    Copyright:

    © All Rights Reserved
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    of 1

    v.

    1 – 08/2022

    Merchant Declaration

    To,
    PhonePe Private Limited (“PhonePe”)
    Unit No.001, Ground Floor, Boston House,
    Suren Road, Off. Andheri-Kurla Road,
    Andheri (East), Mumbai 400093
    Maharashtra, India

    Subject Merchant Declaration

    Deepankar Gope
    I,_____________________________________(partner/owner/director), of_________________
    _____________________________________________________________________________
    RHYTHAM GALAXY GROUP (hereinafter referred to as “Merchant”) do hereby
    declare that below signed specimen signature be considered my authenticated signatures and that I will be the sole
    authorized signatory of the Merchant with respect to the Merchant’s engagement/relationship with PhonePe (including,
    but not limited to, registration/execution/renewal/amendment of the business related
    association(s)/partnership(s)/contract(s)/terms and conditions with PhonePe).

    Specimen Signature
    with seal:
    Name: Deepankar Gope

    I, on behalf of the Merchant, further declare that:

    1. The Merchant is registered under Income Tax Act, 1961 (as may be amended from time to
    time) and have obtained TAN Number _________________________ against the registration. OR

    The Merchant does not hold TAN as it is not liable to deduct tax at source or collect tax at source as per Tick (if
    the provisions of Income Tax Act, 1961. applicable)

    2. The Merchant is registered and GSTIN certificate/acknowledgement having provisional


    number ___________________________ is issued by GST authorities. OR

    The Merchant does not have any registration with GST authorities. Tick (if
    applicable)

    I, having PAN number ___________________,


    AAUFR2706A hereby declare that the above facts and information are true, complete and correct
    to the best of my knowledge. I understand and agree that in case it is found that the above-mentioned facts and information
    are incorrect, I will be personally held liable for the same.

    Yours faithfully,
    For and behalf of the Merchant

    ___________________
    (Signature with Seal)
    Designation: Partner
    Date: 22-06-2023
    Place: Kolkata

    Page 1 of 1

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