CUSTOM HOUSE AGENTS DATA

 

                         NAME OF CHA :
                         ADDRESS :
                         CITY :
                         STATE :
                         PINCODE :
                         TELEPHONES
                                Office :
                                Residence :
                                Fax :
                                Mobile :
                                Pager :
                                Telex :
                         INCOME TAX PAN NO :
                         CHA LICENCE EXPIRY DATE :
                         NAMES OF THE AUTHORISED PERSONS :
NAME AND SIGNATURE
( Authorised Signatory)

 

Notes

         1. Please enclose attested copy of CHA Licence and PAN certificate

         2. All columns should be written legibly and in CAPITAL letters