PAN Payee Declaration Letter

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Payee name, PAN card name and Hospital name Declaration

This is to inform / declare you that we (hospital name) ___________________________________________, located


at____________________________________________________________________________________________
_____________________________________________________________________________________________

According to company incorporation / proprietary concern our hospital name is______________________________


__________________________________________________________________________________________ and
hospital PAN card / existing PAN card name ______________________________________________________and
bank account holder’s name is____________________________________________________________________.

All IT returns will be filed on the following PAN card number and name mentioned below:

Nature of Company / Hospital: Proprietorship / Partnership / Pvt. Ltd / Public Limited (please tick)

Name on the PAN Card _________________________________________________________________________

PAN card No._________________________________________________________________________________

Hospital Account Holders Name / Payee Name (as per bank records)

____________________________________________________________________________________________

Account No.___________________________________ Account type: Savings / Current / CC / Others

IFSC code.____________________________________ MICR No._______________________________

Bank Name._________________________________________________________________________________

Bank Address._______________________________________________________________________________

(Authorized Signatory)

Name____________________________

Designation________________________

Contact Number ____________________

Hospital / Company Seal_______________________

Date : _________________

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