FORM 49 A

Ack No

Application for allotment of Permanent Account Number

Under Section 139 A of the Income Tax Act 1961
(To aviod mistakes please follow the accompanying instruction and Examples
Carefully before filling the Form)
To, Area AO Range Ao
The Assesing Officer Code Type Code No
Ward/Circle ITO DASUYA N W R P 2 0 7 1
Range HOSHIARPUR
Commisioner JALANDHAR
Sir
I/We Hereby request that permanent account number be alloted to me/us
I/We give below necessary Particulars Signature /Left Thumb
Impression
1 Full Name (Full Expanded Name : Initials are Not Permitted)
Please Tick √ as applicable Shri √ Smt Kumari M/s

Last Name /Surname: First Name :

S I N G H M A N J I T
Middle Name

2 Name you would like printed

on the card M A N J I T S I N G H

3 Have you ever been known by other name ? Please tick √ as applicable Yes No √
If Yes ,please give the other Name
(Full Expanded Name : Initials are Not Permitted) Shri Smt Kumari M/s

Last Name /Surname: First Name :

Middle Name

4 Fathers Name (Only individuals applicant : Even Married womwn should give fathers,s name only)
Last Name /Surname: First Name :
S U K H R A J
Middle Name

5 Address:
Residential Address:
Flat/Door/Block/No
H N. O 1 4 0
Name of the Premises/Building /Village
R A J W A L
Road Street /Lane/Post Office
R A J W A L
Area Locality /Taluka/Sub Divisoin
M U K E R I A N
Town /City/District State /Union Territory PIN
H O S H I A R P U R PUNJAB 1 4 4 2 1 6
Office Address : (Name of the Office ) (Indicating Pin Is Mandatory)
G O V T H I G H S C H O O L
Flat/Door/Block/No

Name of the Premises/Building /Village

D I A H A N A
Road Street /Lane/Post Office
D I A H A N A
Area Locality /Taluka/Sub Divisoin
G A. R S H A N K A R
Town /City/District State /Union Territory PIN
H O S H I A R P U R PUNJAB 1 4 4 4 0 6
(Indicating Pin Is Mandatory)
 6 Address for communication : Please Tick( √ ) as applicable R √ O

STD CODE Tel Number

7 Tel.No 0 1 8 8 3 2 3 6 2 8 5 e-mail rohittalwara@yahoo.com

8 Sex (For 'Individulas, Applicant Only ) Please tick as applicable Male √ Female

9 Status of Applicant : Please tick ( ) as applicable

Indivuduals P √ Firm F Body of individuals B

Hindu Undivided Family H Association of Persons A Local Authority L

Company C Association of Persons (Trust) T Artifical Juridical Person J

10 Date of Birth /Incorporation/Aggreement/Partnership or Trust Deed /Formation of Body 0 6 0 1 1 9 8 0

D D M M Y Y Y Y
11 Registration Number (In Case of Firms ,Companies etc.)

12 Whether Citizen of India ? Please tick √ as applicable Yes √ No

13 (a) Are you a salaried employee? If Yes Indicate : Government √ Others

Name of the Organisation where working GOVT HIGH SCHOOL DIHANA

(b) If you are engaged in a business/proffesion indicate nature of business or profession and fill the relevent code.

© If you are not covered by (A) or (b) above ,indicate sorces of income if any

14 Full Name ,address of the representive Assesse who is assesable under the income tax Act in respect of the person whose
particulars have been given in col 1 to 13
Full Name (Full Expanded Name : Initials are Not Permitted) Please tick as applicable
Last Name /Surname: First Name :

Middle Name

Office Address : (Name of the Office )

Flat/Door/Block/No

Name of the Premises/Building /Village

Road Street /Lane/Post Office

Area Locality /Taluka/Sub Divisoin

Town /City/District State /Union Territory PIN

15 I /we have enclosed Voter ID Card as proof of identity and Voter ID Card
as proof of address.
I/we Manjit Singh ,the applicant ,do hereby declare that what is

Signature /left thumb impression of Applicant