EXISTING PAN NUMBER AO CODE: NOTE NOTE:- FOR ( P ) ENTER CAPS " P " Applicant Name: Last Name

First Name Middle Name Name You would like printed on the card FATHER NAME Last Name First Name Middle Name Residential Address Flat/Door/Block No. Name of Premises/Building/Village Road/Street/Lane/Post Office Area/Locality/Taluka/Sub-Division Town/City/District For Change Request State Fill the address in Office Address only. Pin If you want Residence Address, leave Country Name of Office Blank
and proceed

Shri Other Name Yes

C orrection Req.

Address for Communica Residence Sex Male

Status of the Ap Indl LA VIJJU

Name of Office Flat/Door/Block No. Name of Premises/Building/Village Road/Street/Lane/Post Office Area/Locality/Taluka/Sub-Division Town/City/District State Pin Country Tele Phone Number Country Code STD Code Tele Phone Number email ID VIJJU
DATE OF BIRTH / Incorporation / Agreement /
Partnership or Trust Deed / Formation of Body of Individuals / Association of Persons

Office Address

Whether Citizen of In Yes Source Salary Capital Gains

AADHAAR number (if allo

Correction Req.

Registration Number (In case of Firms,

Companies etc.,) Identity Proof Address Proof REPRESENTATIVE DETAILS: Last Name First Name Middle Name

Shri

Representative Address Flat/Door/Block No. Name of Premises/Building/Village Road/Street/Lane/Post Office Area/Locality/Taluka/Sub-Division Town/City/District State Pin PAN SURRENDER Number of Enclosures Signed Person Name Capacity Place Verified today, Dated

Country

Smt Other Name No

Kumari

M/s

C orrection Req.

C orrection Req. Address for Communication Residence Office Sex Female C orrection Req.

C orrection Req. Status of the Applicant Firm BOI HUF Comp AOP(T) AJP

AOP GOV LLP

Whether Citizen of India Yes No Source of income Salary Capital Gains

Business/Profession

House Property No income

Other sources

AADHAAR number (if allotted)

orrection Req.

Smt

Kumari

M/s

Country

Form No. 49A Application for Allotment of Permanent Account Number

[In the case of Indian Citizens/Indian Companies/Entities incorporated in India/ Unincorporated entities formed in India] Under section 139A of the Income Tax Act, 1961
To avoid mistake (s), please follow the accompanying instructions and examples before filling up the form

Only Individuals to affix recent photograph

(3.5 cm x 2.5 cm)

Only Individuals to affix recent photograph

(3.5 cm x 2.5 cm)

Assessing officer (AO code) Area code

Sign / Left Thumb Impression across this photo

AO type

Range code

AO No.

Sir, I/We hereby request that a permanent account number be allotted to me/us. I/We give below necessary particulars: Full Name (Full expanded name to be mentioned as appearing in proof of identity/address documents: initials are not permitted)

Signature/Left Thumb Impression

Please select title,

Last Name / Surname First Name Middle Name

P as applicable

Shri

Smt.

Kumari

M/s

Abbreviation of the above name, as you would like it, to be printed on the PAN card

Have you ever been known by any other name?

If yes, please give that other name

Yes

No

(Please tick as applicable)

Please select title,

Last Name / Surname First Name Middle Name

P as applicable

Shri

Smt.

Kumari

M/s

Gender (for Individual applicants only)

Male

Female

(Please tick as applicable)

Date of Birth/Incorporation/Agreement/Partnership or Trust Deed/ Formation of Body of individuals or Association of Persons Day Month Year

Last Name / Surname First Name Middle Name Address

Residence Address

Father's Name (Only 'Individual' applicants: Even married women should fill in father's name only )

Flat/Room/ Door / Block No. Name of Premises/ Building/ Village Road/Street/ Lane/Post Office Area / Locality / Taluka/ Sub - Division Town / City / District State / Union Territory
Office Address

Pincode / Zip code

Country Name

Name of office Flat/Room/ Door / Block No. Name of Premises/ Building/ Village Road/Street/ Lane/Post Office Area / Locality / Taluka/ Sub - Division Town / City / District State / Union Territory Pincode / Zip code Country Name

Address for Communication Telephone Number & Email ID details

Country code Area/STD Code

Residence

Office

(Please tick as applicable)

Telephone / Mobile number

Email ID Status of applicant

Please select Status,

Individual Trusts

P as applicable
Hindu undivided family Body of Individuals Company Local Authority Partnership Firm Artificial Juridical Persons

Government Association of Persons Limited Liability Partnership

Registration Number (for company, firms, LLPs, etc.)

In case of a citizen of India, then Please mention your AADHAAR number (if allotted) Source of Income
.Salary Income from Business / Profession Income from House property Business/Profession code. [For Code: Refer instructions]

Please select status,

as applicable

Capital Gains Income from Other sources No income

Representative Assessee (RA)

Full name, address of the Representative Assessee, who is assessable under the Income Tax Act in respect of the person, whose particulars have been given in the column 1-13.
Full Name (Full expanded name: initials are not permitted)

Please select title,

Last Name / Surname First Name Middle Name Address

P as applicable

Shri

Smt.

Kumari

M/s

Flat/Room/ Door / Block No. Name of Premises/ Building/ Village Road/Street/ Lane/Post Office Area / Locality / Taluka/ Sub - Division Town / City / District State / Union Territory Pincode / Zip code Country Name

Documents submitted as Proof of Identity(POI) and Proof of Address (POA) I/We have enclosed... as proof of identity and as proof of address. [Please refer to the instructions (as specified in Rule 114 of I.T. Rules, 1962) for list of mandatory certified documents to be submitted as applicable]

I/We...

, the applicant, in the capacity of

do hereby declare that what is stated above is true to the best of my/our information and belief.

Place

D Date

D -

M -

Signature / Left Thumb Impression of Applicant (inside the box)

Request For New PAN Card Or/ And Changes Or Correction in PAN Data
Only Individuals to affix recent photograph Only Individuals to affix recent photograph
(3.5 cm x 2.5 cm)
(3.5 cm x 2.5 cm)

Permanent Account Number (PAN)

Sign / Left Thumb Impression across this photo

Please read Instructions 'h' & 'i' for selecting boxes on left margin of this form.
Signature/Left Thumb Impression

1. Full Name (Full expanded name to be mentioned as appearing in proof of identity/address documents: initials are not permitted)

Please select title,

Last Name / Surname First Name Middle Name

P as applicable

Shri

Smt.

Kumari

M/s

Name you would like it printed on the PAN card

2. Father's Name (Only 'Individual' applicants: Even married women should fill in father's name only ) Last Name / Surname First Name Middle Name 3. Date of Birth/Incorporation/Agreement/Partnership or Trust Deed/ Formation of Body of individuals or Association of Persons Day Month Year

5. Photo Mismatch 7. Address for communication

Male Residence Female Office

4. Gender (for Individual applicants only)

(Please tick as applicable) (Please tick as applicable)

6. Signature Mismatch

Name of office (to be filled only in case of office address) Flat/Room/ Door / Block No. Name of Premises/ Building/ Village Road/Street/ Lane/Post Office Area / Locality / Taluka/ Sub - Division Town / City / District State / Union Territory Pincode / Zip code Country Name

8. If you desire to update your other address also, give required details In additional sheet. 9. Telephone Number & Email ID details
Country code Area/STD Code Telephone / Mobile number

Email ID
10. AADHAAR number (if allotted) 11. Mention other Permanent Account Numbers (PANs) inadvertently allotted to you PAN 1 PAN 1 12. Verification PAN 3 PAN 4

I/We.. I/We have enclosed... Place D Date D M M Y Y Y Y

, the applicant, in the capacity of ..(number of documents) in support of proposed changes/corrections.

.do hereby declare that what is stated above is true to the best of my/our information and belief.

Signature / Left Thumb Impression of Applicant (inside the box)

TO WHOM SO EVER IT MAY CONCERN

Applicant Color Photograph Sign & Stamp of Gazetted Officer

NAME (Full Name including Surname) FATHER'S NAME (Full Name including Surname) DATE OF BIRTH RESIDENTIAL ADDRESS

: :

CONTACT PHONE NUMBER : -

Signature of the Applicant

Signature and Stamp of the Gazetted Officer

Note : This certificate is issuing for PAN Card from the Concern Dept.