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Annexure-A (Certificate that can be used by a Member or Member of Legislative Assembly/Municipal Councillor/Gazetted Officer under subrule (4), rule 114 of Income-tax Rules 1962)
The format can be downloaded from the NSDL website by clicking on the link below.
https://www.tin-nsdl.com/download/Format-of-Gazette-Certificate_03082012.pdf