10a Prateechee Foudation

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FORM NO.

10A
[See rule 17A]

Application for registration of charitable or religious trust or institution under


section 12A(a) of the Income Tax Act, 1961

To,
The Chief Commissioner or Commissioner of Income Tax,
AYAKAR BHAWAN,
SHELTER CHHAK, CUTTACK,
-------------------------------------------,

Sir,

I, HIMANSHU KUMAR DAS on behalf of PRATEECHEE PRAYAS FOUNDATION,


hereby apply, for the registration of the said Society under section 12A of the Income Tax
Act, 1961. The following particulars are furnished herewith:

1. Name of the trust/institution in full (in block letters) : PRATEECHEE PRAYAS


FOUNDATION
2. Address: O T ROAD, BALASORE, PIN-756001, ODISHA.
3. Name(s) and Address(es) of author(s)/founder(s): HIMANSHU KUMAR DAS
4. Date of Creation of the trust or establishment of the institution:06/06/2015
5. Name(s) and address(es) of trustee(s)/manager(s): 1. HIMANSHU KUMAR DAS
2.PURNA CHANDRA RAY
3. AMLAN SHUBHADARSHEE
4. MISS IDAA PRATEECHEE
I also enclose the following documents:

1. (a) Original/Certified copy of the instrument under which the trust/institution was
created/established, together with a copy thereof.
(b) Original/Certified copy of document evidencing the creation of the trust or the
establishment of the institution, together with a copy thereof. [The originals, if
enclosed, will be returned].
2. Two copies of the accounts of the trust/institution for the latest one/two/three years.

I undertake to communicate forthwith any alteration in the terms of the trust, or in the
rules governing the institution made at any time hereafter.

Date:

Signature:
Designation:
Address:

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