Farm No 494 ‘Application for Allotment of Permanent Account Number {In the case of Indian Citizenslindian CompaniesiEntties incorporated in India omy wate Unincorporated entities formed in India] A "sod itt pease olen be scarpangnsucors an atances ee lng pth rm oe eSonrisen) ‘Assessing ofcer (AO code) Trea code Ops ange code RON. ‘Sr, UWe hereby request that a permanent account number be alloted to mals We give below necessary pauls 1 Fu Name Full exzende rane fo be mentoned as appearing nooo dentyacess documents: nal at no part) Please saect ta, [7s sppeabe ‘sha lem. amar we = Wesle Name 2 Abbrovation af he above name, a you would kt, tobe printed onthe PAN card ‘Have you aver been known by any other name? Yes “ (Please tok 5 apace) ity, please give that tbr nama Pease select ste, [\/]as apcable hei sme umes [Jes Mele Name ier (lo individu appean ony) Mato Female (Ptea50 tick as aplicable) '5 Date of Bitvincorporation!AgreemenuPartershp or Teust Ded Formation of Body of ndvduals or Assocation of Persons Day Month Ye ‘5 Father's Name (Only ‘awit applicants: Even maried women shoul fin father's name ony) Mele Name TAcdress Residence Address FouRoomDeorBock No Name of PremsestBulangiilage ‘ait acaltyTaka'Sub OMson TowniciyDistt SatelUson Teton Pincode 2 cod ary Name Name of fee Name of PromsesBusingViage RosdSietLanePost Ofce ‘eal ecaltyTauka'Sub OMson Stattunen Teony Pinca 2 cade County Name Tee or Canario Fasten bere ‘Fiase laas apeabe){9 Telephone Number & Email ID details County cade feealSTD Code “Tolophone / Mobile numbor 10 Status of applicant Pease wet tats, || a apocatie covernmen Js ines Undivided Femi ccomsany Parneship Fim Associaton of Persons frst Body tues LecalAutonty arf Joel Pecans Lets Labity Pararshp ‘+1 Regisraton Number (for company, fms, LLPS, et} 12 Incase ofa ctzon of india, then Piase menion your AADHAAR number aotted) +48 Source of income Pease sac sits, | /]a¢ appeal aly Capt Sone Income tom Busines |Prfessan Busines /Prleson coe Income tom Oe souces Income rm Hous propery No mcome 16 Representative Assosseo (RA) Tox et in apache pesn, whose parkour have be g Fulname, ares oft Representative Assess, nh is assesabio unde te vente alu 113, Ful Name (Full expanded namiials ae nol pennites) Poase sect ile, |\/] a appicable low sot ua Mis Last Name / Surname Middle Name eseoss auRoomDeorBock No, Name of Premises Bulingiilage ‘saiLecltyTauha'Sub-Ovson StaleUon Tero Prado 15 Documents submited as Proof of identity (POI), Proof of Address (POA) and as prot of date of bith (208). We have enclosed 8 prot of int, ‘a roto acres and 288 prot of date of bith [Please refer tothe nseans fas speciogn Rule 14 (ay a7 Tes, 1962) fr to mandatory centied documents o be submited as appsable 161 the applicant, nthe capacty of do heceby declare thal whale saled above Is ue othe best of myfour information and bole Date ‘Sire. Thus eres of Papin ada a)INSTRUCTIONS FOR FILLING FORM 49A Date of BitncorprstionAgreamentParnership or Trust De ormation of Body of inviduleasociaton10. Sinus ot Applicant “Ths lds mandatory Yor al calogoros of apelcarla case f nied Ubi Parner The PAN wl be ated Far sat TT Regitation number cr a sn of indi AADEAAR aie ald aa Oe Guna (Supe y tapy oT AAUHARR Lee AT ret Sled pt spies en a pope nenlpSlsbncode ottoman eB aa | ta eat Sa To [owrerspct ee ec Bowes Malay Sees PAT Proof ange! gsi ae an regure represen zeae ‘RSERonveg na hd an Se ae caer opetan cater ovomen shou om ne ae fear att omar “Gnimatmcetsessredieymoweannctah pen coon ire 1620 a eed en aly fa Gee emma aed Sg ae deer maul Pacer covepre ids ag 2 Ce tly soo Sons's Va fan ase Sentient write —— escton Be Barshiseeawamene 8 > Conn go coremsien rs booker fond gnosis ore bak nome Sarena pr eb: Papas Arun Sere Emeaceioens Meme ree erede Re eee Nakane RAS 2 [Panrenno rm => C2p/ ol Seta RepaionisieabyiheRogiaranns eS Copal param aaed| 3 [Tintin Pareahie opr Guten of Region esna bye Regan LPs 4 [Ramen oe a a OO ap oT RE ERT A RTC COMMA 5 [Reteixnmory, mene SOY tiaNaual | chara fein urbe sve by Chay Commissar repro co-apeave ron Eee eee tantenarar me ety mae manent SESS Dy cove Gremene te Sree 76. Signaturee/Thamb impression: Tages sto sey sper © Fara cant [UF Or tos fa Carry Oy Aaotand Saracen con AOR ayo (sivauen Loca kaon andi neds Pore Su Parmar eno Em Gee) rata Or) Repent Rees Sat 2 inekamenaly etree Aabeatonatoec htm gon ee’ arene soaeefronecdre abe oberaecee =. Fapierspay Sean bp peice ar PA For (aA tor ry PAN Save cetera UTITSL) oan oe Haran VTNa PEPE {Stronach domnovsedner alco Seater sore myn iternmeran ape" ifaL ees aes ch 2 Toelotarpocorens PAN aopcateni 105 faunas) eae he AO car lobe depres ove athe ioral dah raged ihe iode aay con rgtalfanemt: Pa nalcagsy nin hangar uname REGENCE TORT (CUE OT appTSADIS Takes Withetnanks from ShriSmt Aku Ms Application Form 49A Sr. no. Date of Receipt ‘Serves Tax Regn," ARACUAATICSTOORT PAN Service Centor Name = {ith cate stomp) Tor angina he PAN ou Tayo ou woos, va esos quetJcovespangencs hts conealan may be aaeronend Lriswung be Appieaton nse procaeang os USubor Nurwors the adervows ae” bel” Fax any ere3t909 Era © ~ls oad on ‘ “Teaphone 01) 237412828 Fan (081 23741280 Coral D spe dvGs.com \22da 47 TMGa"0 Fan (033) 22638217 Em 1D: Koka com! pan kok cor pone: (Od) - 22600828 E-mail (0 -chonneulihcam "AAYKAR SAMPARK KENDRA (ASK)-Toll Free Nos: 1600-1007961 Atal O01 ape)