Indent for requisition of PAN BULK VERIFICATION service to UTITSL

Sir,
I/We would like to register for the Online PAN Verification service offered by
UTITSL.
I/We give below necessary particulars:
Title Shri Smt. Kumari M/s
Last Name/Surname: First Name: Middle Name:

O. Office Address:(Name of office)

Name of organisation
Address Line 1
Address Line 2
Address Line 3
Address Line 4
Town/City/District
State/Union Territory
Pin(Indicating PIN is mandatory)
Telephone No.
e-mail ID
Digital signature Key*
* Class II Digital Signature can be obtained from any licensed CA of GOI.

Services opted for : (Put a check mark against selected options)

ONLINE PAN VERIFICATION
(Available on registration , upto 750 Rs.12000/- p.a.
PAN numbers per user per day)
FILE UPLOAD Facility Rs.12000/- p.a. + initial Rs.5000/-
(Additional minimum payment of
Rs.5000/- in advance.
Limit of 200 PAN numbers per file.
Deduction of Rs.75/- per file download
will be effected from the payment of
Rs.5000/-)
Software based PAN verification
facility (Additional minimum payment
of Rs.5000/- in advance. Deduction of
Rs.12000/- p.a. + initial Rs.5000/-
37.5 paisa per PAN number queried,
over and above 750 PAN numbers
queried per user per day. )
Net Amount
Service Tax @12.36%
Gross Amount

1. Payment Details

Demand Draft/Pay Order(in favour of 'UTITSL-PAN Bulk Verification ' ) payable at

Mumbai.
Select Payment Mode
Demand Draft Pay Order
Demand Draft number ___________________ Dated ______________
Total Amount- ________________- and Service tax@12.36%
Drawn On __________________________ Bank and Branch, payable at Mumbai.
OR
Pay Order number _______________Dated _______________
Total Amount-_________________/- and Service tax@12.36%
Drawn On _______________________________Bank, Branch, payable at Mumbai.

Any additional specific requirements of the user:

(The requirement and commercials proposed will be discussed with ITD and if
approved, will be taken up by UTITSL )

Signature (attested)