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<wordtidy><div align="center" style="margin-top:2.95pt;margin-right:184.3pt; margin-bottom:0cm;margin-left:183.2pt;margin-bottom:.0001pt;text-align:center"><strong>FORM II-C</strong></div><div align="center" style="margin-top:2.95pt;margin-right:184.3pt; margin-bottom:0cm;margin-left:183.2pt;margin-bottom:.0001pt;text-align:center"><strong><br></strong></div> <div align="center" style="margin-top:3.0pt;margin-right:15.1pt; margin-bottom:0cm;margin-left:14.0pt;margin-bottom:.0001pt;text-align:center; text-indent:.05pt"><strong>CERTIFICATE TO BE FURNISHED BY A PERSON WHO IS SIMULTANEOUSLY ENGAGED IN EMPLOYMENT OF MORE THAN ONE EMPLOYER.</strong></div> <div style="margin-top:.4pt;line-height:5.0pt;mso-line-height-rule: exactly"> </div> <div align="center" style="margin-top:0cm;margin-right:187.75pt; margin-bottom:0cm;margin-left:186.7pt;margin-bottom:.0001pt;text-align:center">(See rule 9A)</div><div align="center" style="margin-top:0cm;margin-right:187.75pt; margin-bottom:0cm;margin-left:186.7pt;margin-bottom:.0001pt;text-align:center"><br></div> <div style="line-height:6.0pt;mso-line-height-rule:exactly"> </div> <div style="text-align: justify; margin: 0cm 3.9pt 0.0001pt 5pt; text-indent: 36pt;">I ..................................................... (name) .......................................................................................... (address) hereby certify that I am engaged in employments with the following employers, namely :-</div> <div style="margin-top:.05pt;line-height:7.0pt;mso-line-height-rule: exactly"> </div> <div align="center" style="margin-top:0cm;margin-right:40.1pt; margin-bottom:0cm;margin-left:48.1pt;margin-bottom:.0001pt;text-align:center; line-height:13.0pt;mso-line-height-rule:exactly">Name of the employer Address of the employer</div> <div style="margin-top:.2pt;line-height:7.0pt;mso-line-height-rule: exactly"> </div> <div style="margin-left:5.0pt">1.</div> <div style="line-height:6.0pt;mso-line-height-rule:exactly"> </div> <div style="margin-left:5.0pt">2.</div> <div style="line-height:6.0pt;mso-line-height-rule:exactly"> </div> <div style="margin-left:5.0pt">3.</div> <div style="line-height:6.0pt;mso-line-height-rule:exactly"> </div> <div style="margin-left:5.0pt">4.</div> <div style="margin-top:.05pt;line-height:6.0pt;mso-line-height-rule: exactly"> </div> <div style="margin-left:5.0pt">5.</div><div style="margin-left:5.0pt"><br></div> <div style="margin-top:.45pt;line-height:7.0pt;mso-line-height-rule: exactly"> <span style="white-space:pre"> </span>*I shall get myself enrolled and shall pay the tax</div> <div style="margin-top:.5pt;line-height:6.0pt;mso-line-height-rule: exactly"> </div> <div style="text-align: justify; margin: 0cm 3.85pt 0.0001pt 5pt; line-height: 13pt;"> *I have got myself enrolled and have paid the tax/shall pay the tax.</div><div style="text-align: justify; margin: 0cm 3.85pt 0.0001pt 5pt; line-height: 13pt;"> I hold the enrolment certificate No ................................. dated .............................</div><div style="text-align: justify; margin: 0cm 4.85pt 0.0001pt 5pt; line-height: 143%;"><br></div><div style="text-align: justify; margin: 0cm 4.85pt 0.0001pt 5pt; line-height: 143%;">Place: ........................................</div> <div style="margin-top:.2pt;margin-right:0cm;margin-bottom:0cm; margin-left:5.0pt;margin-bottom:.0001pt">Date .......................................... </div><div style="text-align: right; margin: 0.2pt 0cm 0.0001pt 5pt;">Signature .....................................</div><div style="text-align: right; margin: 0.2pt 0cm 0.0001pt 5pt;"> </div> <div style="margin-left:5.0pt">Note: *Strike out whichever is not applicable</div><div style="margin-left:5.0pt"><br></div> </wordtidy>
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