Annexure III to CSRF 1
TO BE FILLED/ATTESTED BY DDO/POP-SP/NL-CC
Certified that the above declaration and nomination details has been signed / thumb impressed before me by Sh/Smt/Ms.
after he / she have read the entries / entries have been read over to him / her by me and got confirmed by him / her.
Rubber Stamp of the DDO/POP-SP/NL-CC
Signature of the Authorised Person
DDO/POP-SP/NL-CC Registration Number
Designation of the Authorised Person :
(Allotted by CRA)
DDO/POP-SP/NL-CC Office Name :
Date
d
d
/
m m
/
y
y
y
y
TO BE FILLED/ATTESTED BY PAO/DTO/POP/POP-SP/NL-AO/DTA/PrAO
PAO/DTO/POP/POP-SP/NL-AO/DTA/PrAO Registration Number
(Allotted by CRA):
Rubber Stamp of the PAO/DTO/POP/POP-SP/NL-AO/DTA/PrAO
Signature of the Authorised Person