Form-401-An - Annexure For Nomination Details (Page 2 of 2) in pdf

Form-401-An - Annexure For Nomination Details Page 2

Form 401-AN

Page 2

Dated this ______________day of____________20

at ______________.

Particulars

Witness

Name

Address

Signature/Left Thumb

Signature

Impression of the Subscriber

*Note: Left thumb impression in case of illiterate male Subscriber and Right thumb impression in case of illiterate female subscriber

must be obtained.

TO BE FILLED/ATTESTED BY DDO/POP-SP

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.

Signature of the Authorised Person

Rubber Stamp of the DDO/POP-SP

DDO/POP-SP Registration Number _______________________

Designation of the Authorised Person : ________________________________

(Allotted by CRA)

DDO/POP-SP Office Name : ___________________________________

Date :

D M M Y Y Y Y

TO BE FILLED/ATTESTED BY PAO/DTO/POP/POP-SP

PAO/DTO/POP Registration Number (Allotted by CRA):_____________

___________________________________________________________

Rubber Stamp of the PAO/DTO/POP/POP-SP

Signature of the Authorised Person

Form-401-An - Annexure For Nomination Details Page 2