No Yes Date : Name INSTRUCTIONS Documents which can be produced in support of the address are :- Ration card Passport above is Driving license Identity card issued by any institution Copy of the electricity bill or telephone bill showing residential address Any document or communication issued by any authority of Central Government, State Government or local local bodies showing residential address Any other documentary evidence in support of his address given in the declaration. Published on National Portal of India (india.gov.in) Government of Orissa Application for Declaration to be Filed by a Person who does not have either a Permanent Account Number ( See third proviso to Rule 114B ) FORM NO. 60 Form of declaration to be filed by a person who does not have either a Permanent Account Number or General Index Register Number and who makes payment in cash in respect of transaction specified in clauses (a) to (h) of Rule 114B. Full Name and Address of the Declarant 1. Particulars of the transaction 2. /- 3. Amount of the transaction (Rs.) Are you assessed to tax ? 4. If Yes : (i) Details of Ward / Circle / Range where the last return of income was filed (ii) Reasons for not having Permanent Account Number/General Index Register Number Details of the documents being produced in 5. support of address in column (1) : VERIFICATION do hereby declare that what is I, stated above is true to the best of my knowledge and belief. Verified today, the Place : Signature
