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Signed - Declaration Form

The document is a merchant declaration form for SE Finance Private Limited. It contains the specimen signature of Akshay Mittal, Director of SE Finance Private Limited, authorizing him as the sole signatory for the merchant's relationship with PhonePe. It also contains declarations that the merchant is registered under the Income Tax Act with TAN number DELS67084D and GSTIN number AJBPM0725E. Akshay Mittal declares that the facts and information provided are true and correct to the best of his knowledge.

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himanshu chhabra
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© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
66 views

Signed - Declaration Form

The document is a merchant declaration form for SE Finance Private Limited. It contains the specimen signature of Akshay Mittal, Director of SE Finance Private Limited, authorizing him as the sole signatory for the merchant's relationship with PhonePe. It also contains declarations that the merchant is registered under the Income Tax Act with TAN number DELS67084D and GSTIN number AJBPM0725E. Akshay Mittal declares that the facts and information provided are true and correct to the best of his knowledge.

Uploaded by

himanshu chhabra
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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v.

1 – 08/2022

Merchant Declaration

To,
PhonePe Private Limited (“PhonePe”)
Unit No.001, Ground Floor, Boston House,
Suren Road, Off. Andheri-Kurla Road,
Andheri (East), Mumbai 400093
Maharashtra, India

Subject Merchant Declaration

Akshay Mittal
I,____________________________________(director), of_________________
_____________________________________________________________________________
SE Finance Private Limited (hereinafter referred to as Merchant”) do hereby
declare that below signed specimen signature be considered my authenticated signatures and that I will be the sole
authorized signatory of the Merchant with respect to the Merchant’s engagement/relationship with PhonePe (including,
but not limited to, registration/execution/renewal/amendment of the business related
association(s)/partnership(s)/contract(s)/terms and conditions with PhonePe).

Specimen Signature
with seal:
Name: Akshay Mittal

I, on behalf of the Merchant, further declare that:

1. The Merchant is registered under Income Tax Act, 1961 (as may be amended from time to
DELS67084D
time) and have obtained TAN Number _________________________ against the registration. R

The Merchant does not hold TAN as it is not liable to deduct tax at source or collect tax at source as per Tick (if
the provisions of Income Tax Act, 1961. applicable)

2. The Merchant is registered and GSTIN certificate/acknowledgement having provisional


number ___________________________ is issued by GST authorities. OR

The Merchant does not have any registration with GST authorities. Tick (if
applicable)

AJBPM0725E hereby declare that the above facts and information are true, complete and correct
I, having PAN number ___________________,
to the best of my knowledge. I understand and agree that in case it is found that the above-mentioned facts and information
are incorrect, I will be personally held liable for the same.

Yours faithfully,
For and behalf of the Merchant

___________________
(Signature with Seal)
Designation: Director
Date: 21 Jun 2023
Place: Bhopal

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