7/14/2017 https://www.myutiitsl.com/PAN_ONLINE/getPANDetailsPANApp.

action

Form 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

Date: 13/07/2017
Print

AADHAAR matched using Demographic details - will be linked with your PAN.

Payment Status: Success

Your Payment of Rs.110.00/- for one PAN Application has been accepted subject to realization
and final settlement confirmation from your Banker.
Please quote Reference No. JURP5495844381 for any future correspondence.

Application number : U-N001943686

Coupon number : U-N001943686

Assessing Officer(AO Code)

Area Code AO Type Range Code AO No
APR W 86 1

1. Full Name (Full expanded name: initials are not permitted):

Last Name / Surname :- First Name:- VENKATA
Title:- SHRI Middle Name:- ABHISHEK
SOMAYAJULA SANTOSH
2. Abbreviation of the above name, as you would like it, to be printed on the PAN card:- SOMAYAJULA VENKATA
SANTOSH ABHISHEK
3. Have you been known by any other name? N
Last Name / Surname :- First Name:- Middle Name:-
4. Gender:- MALE
5.Date of Birth / Incorporation/Agreement/Partnership or Trust Deed/Formation of Body
06/08/1998
of Individuals/Association of Persons:-
Last Name / Surname :- Middle Name:-
6. Father's Name : First Name:- BALA
SOMAYAJULA SUBRAHMANYAM
Last Name / Surname :-
Mother's Name : First Name:- RAJESWARI Middle Name:-
SOMAYAJULA
The name of either father or mother which you may
FATHER'S NAME
like to be printed on PAN card :

https://www.myutiitsl.com/PAN_ONLINE/getPANDetailsPANApp.action 1/3
7/14/2017 https://www.myutiitsl.com/PAN_ONLINE/getPANDetailsPANApp.action

7. Address:-
Residential Address:-
Flat/Door/Block No.:- 15-57/2, MIG-II 28
Name of
NEAR LALITHA TEMPLE
Premises/Building/Village:-
Road/Street/Lane/Post
LAST BUS STOP
Office:-
Area/Locality/Taluka/Sub-
POTHINAMALLAYA PALEM
Division:-
State/Union
Town/City/District:- PIN Code:-
Territory:- ANDHRA Country:- INDIA Zip:-
VISAKHAPATNAM 530041
PRADESH
Official Address:-
Office Name:-
Flat/Door/Block No.:-
Name of
Premises/Building/Village:-
Road/Street/Lane/Post
Office:-
Area/Locality/Taluka/Sub-
Division:-
State/Union
Town/City/District:- PIN Code:- Country:- Country:-
Territory:-
8. Address for
RESIDENCE
Communication:-

9. Telephone Number & Email ID Details :-

Country Area/STD Telephone/Mobile Email
91 0891 9912379389 ssb071296@gmail.com
Code:- Code:- Number:- Address:-
10. Status of the Applicant:- Individual
11. Registration Number(for
Company,firms,LLP's etc):-
12. Please Mention your AADHAAR
624774299904
Number(if allotted) :-
If AADHAAR number is not allotted,
please mention the enrolment ID of
Aadhaar application form :-
Name as per AADHAAR letter/card or
as per the Enrolment ID of Aadhaar SOMAYAJULA VENKATA SANTOSH ABHISHEK
application form :-

13.Source of Income

SALARIED Capital Gains

Income from Business/Profession Income from Other sources

Income from House property No income

14. 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 colmns 1 to 13.
Title:- Last Name:- Middle Name:- First Name:-
Flat/Door/Block No.:-
Name of
Premises/Building/Village:-

https://www.myutiitsl.com/PAN_ONLINE/getPANDetailsPANApp.action 2/3
7/14/2017 https://www.myutiitsl.com/PAN_ONLINE/getPANDetailsPANApp.action

Road/Street/Lane/Post
Office:-
Area/Locality/Taluka/Sub-
Division:-
Town/City/District:- State/Union Territory:- PIN Code:-

15. I/We have enclosed AADHAAR Card issued by UIDAI (In Copy) as Proof of Identity , AADHAAR Card issued by
UIDAI (In Copy) as Proof of Address and AADHAAR Card issued by UIDAI (In Copy) as Proof of DOB.
16. I/We SOMAYAJULA VENKATA SANTOSH ABHISHEK ,the applicant,in the capacity of HIMSELF/HERSELF do hereby
declare that what is stated above is true to the best of my/our information and belief.

VISAKHAPATNAM

Signature/Left thumb impression of the

Place Date
applicant

https://www.myutiitsl.com/PAN_ONLINE/getPANDetailsPANApp.action 3/3