Bengaluru-560500 Õ´»ÜôÚ 560500

Telephone: 18001034455 (Toll Free) or 080-46605200 $ÈôÙ:18001034455 (ÅæòÜÈ÷Úè) 080 - 46605200

ITARQPG29219P1819IN
Response Sheet Order
PAN AY
Communication Communication
Reference No. Reference No.

ARQPG2929P 2018-19 CPC/1819/G3c/1878102930 CPC/1819/A4/1878102930

Particulars of Bank account / Address Details

Does the Bank Account Number mentioned in the return Yes No

belong to you?
If Yes, please attach documentary proof in respect of the
same

Bank Account No.

If No, please indicate Bank Account Number standing in

IFSC Code
your name along with IFSC Code, Account Type and
attach documentary proof in respect of the same Account Type: Savings

Current

Does the Address mentioned in the return belong to you?

Yes No
If Yes, please attach documentary proof in respect of the
same

If No, please provide Address standing in your name and

attach documentary proof in respect of the same

The return for the above said assessment Year is processed but issue of refund has failed at CPC. Request you to fill this
response sheet and attach the list of document(s) mentioned below and send it by post to CPC for processing your refund
reissue request.

Name of Taxpayer:
Date:
Place:

Signature of Taxpayer

Page 1 of 2
18195335233000
Note:

. Please attach necessary documentary proof for Bank Account / Address as applicable in your case.
. Taxpayers can also file an Online Refund Re-issue request on E-Filing website by providing the account details,
such as account number, IFSC Code & account Type, of the account which is linked with your PAN.

Documentary proof for Bank Account: ORIGINAL AND CANCELLED CHEQUE LEAF issued by the bank with the Account
Number, IFSC Code and Name of the Account Holder pre-printed. Please ensure that the cheque is duly cancelled by writing
“Cancelled” across the face of the cheque leaf. The department will not be liable for any damage arising out of un-cancelled
cheque. Photocopy of cheque leaf will not be accepted.

Documentary proof for Address: Self-attested copy of any one of the following document(s)
Valid Passport
Election commission Photo ID Card
Aadhar Letter / Card / E-Aadhar
Latest Electricity / Telephone (Landline/Postpaid Mobile) / Gas / Water Bill
Valid Driving License
Ration Card
Photo Pass Book of running bank account (Scheduled Public Sector Banks / Scheduled Private Sector Indian Banks and
Regional Rural Banks only)

Page 2 of 2