Abhi

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SELF-DECLARATION

I. Mr/Ms --'C.
...;::...
< Sc!m_i_a_lam khan. Field officer.
hereby on behalf of our company :4Jar~l!ocessors envate 11m11silate that Lhat our produc t /
service qualifies under permissible manufacturing / service I raw material supplier as per Lhe
Government order dated 02rd May, 2020.

Our company produces products/raw m aterial/cater services as


mentioned below:

wood, cork, straw


and plaiting
materials.

The products/raw material/cater services are provided to below


mentioned companies:
METAL CARE ALLOYS PRIVATE LIMITED.,
OM SHREE GANESH CABLE VISION PRIVATE L

I. Mr/Ms << Sami alam km:an, .,> hereby declare that the above
information provided is true to my knowledge and I take complete responsibility of any
information tbat is found to be misleading in this application.

Applicant Name: Sarni alam khan


Designation: Field officer.
Mobile No:
8433626459.
Email id:
samialamk9@gmail.co1
Signature: .

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