The Orissa Entry Tax - Forms
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FORM E17C

[See rule 4 (2)]

FORM OF DECLARATION OF MANAGER/EMPLOYEE/PERSONS ASSOCIATED WITH THE BUSINESS

I ___________________________ Son/ Daughter/Wife of ____________________

Status _____________________________ of the business ___________________________

Address _____________________________________________________________________

hereby declare that the following person(s) is/are Manager(s) or person(s) duly authorized in respect of the above business and all notices, orders and other communications of the Circle office served on him or either of them, as the case may be, shall be binding for all purpose and intent.

Sl. No.

Name and Designation

Name of Father/Husband

Address

Telephone No.

Signature in token of acceptance

I further declare that any notice, order or communication served on the following persons in respect of the above business shall be binding for all purposes and intent.

Sl. No.

Name

Name of Father/Husband

Designation with reference to the business

Address with Telephone No.

Signature in token of acceptance

DECLARATION

I undertake to intimate to the Circle office within seven days, of any change occurring in any of the particulars given above, falling which it will be deemed that the persons are continuing in their respective posts or the authorisation made in respect of such persons is continuing and valid and their actions shall be binding for all purpose and intent.

Signature _________________________

Date ________________________