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Acknowledgment for Request for New PAN Card

Acknowledgment for Request for New PAN Card

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Published by premsam_25

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Published by: premsam_25 on Nov 21, 2009
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Citizen of India Category Name Name to be printed on card Father's Name Date of Birth Residential Address Y Individual Kumari Renuka Rengasamy Renuka Rengasamy Shri Rengasamy Vedhaiya 25-06-1988 228-C Fathima Nagar Nanjikkottai Road Thanjavur - 613001 Tamil Nadu

Affix recent photograph (3.5cm x 2.5cm)

Office Address -

Address for Communication Telephone No Email Id

Residential 91 - 9751793878 premsam.25@gmail.com

Payment Mode
Demand Draft: Number 185413003605 dated 21-11-2009 (in dd/mm/yyyy form) for Rs.94.00 in favour of 'NSDLPAN', drawn on Canara , payable at Mumbai. I/We, the applicant, do hereby declare that what is stated above is true to the best of my/our information and belief. The following documents are enclosed as: Proof of Identity: Copy of passport Proof of Address: Copy of voter's identity card Proof of Identity of representative assessee: Proof of Address of representative assessee: Any other document: Signature/Left Thumb Impression of Applicant (inside the box without touching the sides & in BLACK INK ONLY) Date: 21 - 11 - 2009
Preview Application Form New Application

Service Tax Registration No.: M-III/ST/BAS/2847


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The acknowledgement number above is your unique reference number for PAN application. Kindly quote this number for tracking the status of your PAN application on http://tin-nsdl.com or any queries relating thereto. Save and print this acknowledgment. Application fee and mode of payment: Payment favouring 'NSDL-PAN' can be made as follows:

Sr. No. 1

Address for Communication Indian

Amount payable (Rs.) 94

Mode of payment Credit card/ Demand Draft (DD) payable at Mumbai/Cheque to be deposited in any HDFC bank branch across the country (except Dahej). DD payable at Mumbai




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Please mention name of applicant and acknowledgment number on the reverse of cheque/DD. Individual applicants affix your recent colour photograph (3.5 cm x 2.5 cm), sign the acknowledgment (inside the box provided without touching the sides and in BLACK INK only) and enclose a DD, if any, alongwith Proof of Identity & Proof of Address as specified in the application form. Superscribe the envelope with 'APPLICATION FOR PAN - Acknowledgment Number' (e.g. 'APPLICATION FOR PAN 881010100000973'). Send the documents as specified in point no. 4 above to Income Tax PAN Services Unit, National Securities Depository Limited, 3rd floor, Sapphire Chambers, Near Baner Telephone Exchange, Baner Pune -411045 Tel: 020-27218080; Fax: 020-27218081. Your acknowledgment, Demand Draft if any, and proofs, should reach NSDL within 15 days from the date of online application. Application will be processed only on receipt of relevant proofs and realisation of payment. PAN card will be despatched only to the communication address provided in your PAN application. Wherever the Representative Assessee (RA) details ( item no.14 in Form 49A ) are mentioned in the application, PAN card will be despatched to the RA's address.

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