Bank of America



Instructions: This declaration is required to be submitted on organisation letter-head with organisation seal affixed. The person signing the declaration shall either be a Company Secretary or Director or any other officer as authorized by the organisation to provide such a declaration. The person signing the declaration shall provide a dated and certified copy of his / her Aadhaar / Passport / Driving License along with the declaration. It is the responsibility of the organisation to exercise adequate due diligence before providing the declaration. Please note this declaration is applicable only if any of the Authorized Person(s) is / are not eligible to obtain an Aadhaar number in accordance with the provisions of The Aadhaar (targeted delivery of financial and other subsidies, benefits and services) Act, 2016 (“Aadhaar Act, 2016”)AADHAAR ACT - DECLARATION FORM (on letterhead)ToThe Branch Manager,Date: _ _/ _ _ / _ _ _ _ Bank of America, N.A.…………………BranchI…………………………………………………………………………………………………..…………………………………………………………. (Name of the Authorized Person) working as …………………………………………………………………………………………………………………………………………………… (Designation) with …………………………………………………………………………………………………………………………………………………………………………… (Name of the organisation), declare that I have been granted the authority to provide this declaration, on behalf of my organisation. I have attached a dated and certified copy of my Aadhaar / Passport / Driving License along with this declaration for your records. Further, I declare the following:I declare that the Authorized Person(s) mentioned in Annexure A is/are not covered in definition of a “resident” as defined in Section 2(v) of The Aadhaar (targeted delivery of financial and other subsidies, benefits and services) Act, 2016 (“Aadhaar Act, 2016”) and thus, he / she / they are not eligible to obtain an Aadhaar number. I declare that if required, he / she / they can furnish the documentary proof to evidence that he / she / they is/are not a “resident” as defined in Section 2(v) of the Aadhaar Act, 2016.I acknowledge, that in case he / she / any of them become eligible for Aadhaar number in future, it is my duty to submit to you proof of application towards enrolment for Aadhaar or Aadhaar Details as applicable along with necessary documents.Further, I declare that:For each, Authorized Person(s) with regard to PAN, I have indicated “Yes” in Column 2 or Column 3 as applicable, in Annexure A and I have enclosed self-attested copy of PAN or “Form 60” as defined in the Income-tax Rules, 1962, for each such Authorized Person along with this declaration. For the Authorized Person (s) who have not submitted PAN or “Form 60” as defined in the Income-tax Rules, 1962, I have indicated his / her / their Passport / Driving License details in Columns 4, 5 and 6 in Annexure A. Authorised person (s) have been notified of and have provided their consent to the collection, use and disclosure of the information by Bank of America N.A. India branches for the purpose of authentication.Further, I understand that it is my duty to inform you the PAN details after any of such Authorised Person have been assigned a PAN in future. 3. I hereby declare that all the above information is true, correct and complete.Yours faithfully (Signature of Company Secretary or Director or Authorized Signatory) Name of the Company Secretary or Director or Authorized SignatoryDECLARATION FORMAnnexure AList of Authorized Person (s), who is/are not covered in definition of a “resident” as defined in Section 2(v) of The Aadhaar (targeted delivery of financial and other subsidies, benefits and services) Act, 2016 (“Aadhaar Act, 2016”) and thus, he/she/they are not eligible to obtain an Aadhaar number. BANK / LOAN / CORPORATE CARD RELATIONSHIP ACCOUNT NUMBER: _______________________________________________________S. No.Name of Authorized Person (Please type/write in BLOCK Letters)PAN Details(Please indicate Yes / No / Not Applicable (NA) against each Authorized Person)Passport Details / Driving License Details(If PAN Number / Form 60 is not submitted)PAN Number Form 60Passport Number / Driving License NumberCountry of IssuanceDate of Expiry123456(Signature of Company Secretary or Director or Authorized Signatory) Name of the Company Secretary or Director or Authorized Signatory ................
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