Form No.

49A Application for Allotment of Permanent Account Number
Under Section 139A of the Income Tax Act, 1961 (To avoid mistake(s), please follow the accompanying instructions and examples carefully before filling up the form)

Form No. ITS 49A

To The Assessing Officer Ward/ Circle Range Commissioner Sir,

Area Code

AO Type

Range Code

AO No.

Only 'Individuals' to affix recent photograph (3.5 cm x 2.5 cm)

I/We hereby request that a permanent account number be allotted to me/us. I/We give below necessary particulars : 1. Full Name (Full expanded name : initials are not permitted) Please Tick as applicable Last Name / Surname Shri Smt. ✔ Kumari M/s First Name

Signature/ Left Thumb Impression

S

U K H

A

D

I

A
Middle Name

P P A R T I S H S O T U K T A M D I
Yes M/s

R I

T

I

2 Name you would like printed on the card

P

R

I

H A

A
No

3 Have you ever been known by any other name? If yes, please give that other name (Full expanded name : initials are not permitted) Last Name / Surname

Please Tick Shri Smt.

as applicable Kumari ✔

First Name

M O T

I

V

A

R A

S
Middle Name

P R I J A Y

T R A M

4. Father's Name (Only 'Individual' applicants : Even married women should give father's name only) First Name Last Name / Surname

M O T

I

V

A

R

A S
Middle Name

J S H A M J I

A

Y

R

A

M

5. Address R. Residential Address Flat/Door/Block No.

R O B R C M N U O

O M I L D

N I L D A

O N A

. G N

1 N O E D I
State / Union Territory Pin

Name of Premises / Building / Village

.

1

5

L

A L

T

A

B

E

L

A

Road / Street / Lane / Post Office

P A N

Area / Locality / Taluka / Sub - Division

H A

A N I

W A

Town / City / District

U M B I L

MAHARASHTRA

4 0

0

0

0

2

O. Office Address (Name of Office) Flat/Door/Block No.

(Indicating PIN is mandatory)

Name of Premises / Building / Village

Road / Street / Lane / Post Office Area / Locality / Taluka / Sub - Division State / Union Territory Pin (Indicating PIN is mandatory)

Town / City / District

6. Address for communication Please Tick

as applicable

R

or O

STD Code 7. Tel. No.

Tel. No.

2

2

9

8

6

7

7

2

5

4

3

6

email ID Male Female

8. Sex (For 'Individual' Applicants only) Please Tick 9. Status of the Applicant Individual P Please Tick

as applicable

as applicable Firm F A T Body of Individuals B Local Authority L Aritificial Juridical Person J

Hindu Undivided Family H Company C

Association of Person Association of Persons (Trusts)

10. Date of Birth / Incorporation / Agreement / Partnership or Trust Deed / Formation of Body of Individuals/ Associastions of Persons

2
D

2
D

0

1

1

9

6
Y

5
Y

M M

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 Name of the Organisation where working

Others

(b) If you are enganged in a business/ profession, indicate nature of business or profession and fill the relevant code

(c) If you are not covered by (a) or (b) above, indicate sources of income, if any

DOING ODD JOBS AND DOMESTIC HOUSE WORK.
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) Please tick as applicable Shri Smt. Kumari M/s Last Name / Surname First Name

N

O T

A

P

P

L

I

C

A B

L

E

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 Pin (Indicating PIN is mandatory) as

State / Union Territory

15. I/We have enclosed proof of address

SCHOOL LEAVING CERTIFICATE

as proof of idenity and RATION CARD

PRITI PARSHOTTAM SUKHADIA I/We what is stated above is true to the best of my/our information and belief.

, the applicant, do hereby declare that

Verified today, the

0
D

3
D

1

2

2

0

0
Y

9
Y

M M

Y Y

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

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