Request For New Pan Card Or / And changes Or Correction in PAN Date

Parmanent Account Number (PAN) Please read Instructions 'f' & 'g' for selecting boxes pn left margin of this form

1 Name Place Tick Shir Last Name / Surname

as applicable Smt.

Kumari

M/s
(Signature / Left Thumb Impression)

First Name Middle Name

Name you would like printed on the card 2 Father's Name (Only 'individul' applicants : Even married women should give 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 individual / Assiociation of Persons 4 5 6 7 Sex (for 'Individual' applicants only) Please Tick as applicable Photo Mismatch Yes No Signature Mismatch Yes No Address for Communication Please Indicate if this is Residence Office Name ( to be filled only in case of office address Flat / Door / Block No. Name of Premises / Building / Village Road / Street / Lane / Post Office Area / Locality / Taluka / Sub-Division Town / City / District State / Union Territory Pin Male Female

or Office

8 If you desire to update your other address also, give required details in additional sheet. STD Code Tel .No. 9 Tel. No. E-mail ID Mention other Permanent Account Numbers (PANs) inadvertently allotted to you 10 PAN 1 PAN 3 PAN 2 PAN 4

I/We have enclosed as proof of identity and as proof of address I/We the applicant, do hereby declare that What is stated above is true to the best of my / our information and belief.

Verified today the

Signature / Left Thumb Impression of Applicant

Form No. 49A APPLICATION FOR ALLOTMENT OFK PERMANENT ACCOUNT NUMBER Under Section 139A of the Income Tax Act 1961 To, The Assessing Officer Area Code Ward / Circle Range Commissioner Sir, I/ We hereby request that a permanent account number be alltocted to me/us. I/We give below necessary particulars:
(Signature / Left Thumb Impression)

AO Range Type Code

AO No.

1 Full Name (Full expanded name : initials are not permitted) Place Tick as applicable Shir Last Name / Surname Middle Name 2 Name you would like printed on the card A S O K K U M A R 3 Have you ever beebn knownby any other name ? If yes, please give that other name (Full expanded name, initials are not permitted) Shir Last Name / Surname Middle Name

Smt.

Kumari First Name A S O K

M/s

K U M A R

Place Tick

as applicable

Yes

No

Smt.

Kumari First Name

M/s

4 Father's Name (Only 'individul' applicants : Even married women should give father's name only) Last Name / Surname First Name R A J A N Middle Name 5 Address R.Residential Address Flat / Door / Block No. 70 Name of Premises / Building / Village Road / Street / Lane / Post Office A N B U N A G A R 3 rd S T Area / Locality / Taluka / Sub-Division Town / City / District A R U P P U K O T T A I O. Office Address ( 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 / Union Territory Pin

R E E

State / Union Territory TAMIL NADU

Pin 6 2

6 1

6 Address for communication Please Tick as applicable R O STD Code Tel .No. 7 Tel. No. 9 1 9 3 6 4 4 2 2 5 5 3 E-mail ID asok3151975@gmail.com 8 Sex (for 'Individual' applicants only) 9 Status of the Applicant Individual Please Tick as applicable as applicable Firm Body of Individuals Local Authority Artificial Jurisdical Person 0 5 0 4 1 9 7 Male

Female

Please Tick

Hindu Undivided Family Association of Persons Company Association of Persons(Trust) 10 Date of Birth / Incorporation / Agreement / Partnership or Trust Deed / Formation of Body of individual / Assiociation of Persons 11 Registration Number ( In case of Firms, Companies etc.) 12 Whether citizen of India ? Place Tick as applicable 13 (a) Are you a salaried employee ? If yes, indicate Government Name of Organisatopm where working Yes

Other

No

(b) If you are engaged in a business / profession, indicate nature of business or profession and fill the relevant code If you are not covered by (a) or (b) above, indicate source of income, if any

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 column 1 to 13. Full Name (Full expanded name : initials are not permitted) Place Tick as applicable Shir Last Name / Surname Middle Name Address Flat / Door / Block No. Name of Premises / Building / Village Road / Street / Lane / Post Office Area / Locality / Taluka / Sub-Division Town / City / District State / Union Territory Pin VOTERS ID CARD the applicant, do hereby declare that Smt. Kumari First Name M/s

15 I/We have enclosed DRIVING LICENCE as proof of identity and as proof of address I/We R.ASOK KUMAR What is stated above is true to the best of my / our information and belief.

Verified today the

Signature / Left Thumb Impression of Applicant