You are on page 1of 2


Category Individual Permanent AHNPG0542R Account Number (PAN) Name Shri Srinivas Reddy Gattupalli Name to be SRINIVAS REDDY printed on card GATTUPALLI Father's Name Shri Mohan Reddy Gattupalli Date of Birth 05 - 09 - 1976 Address for Communication G-4 Shourya Avenue Road No - 5 Alakapuri, RK Puram Hyderabad 500035 Andhra Pradesh Investleaf Management Solutions Pvt Ltd 501 Chaitanya Chambers Chaitanyapuri Dilsukhnagar Hyderabad - 500060 Andhra Pradesh 91 9963699435 Signature

Affix recent photograph (3.5cm x 2.5cm) Signature/Left Thumb Impression across this photo

Affix recent photograph (3.5cm x 2.5cm)

Other Address

Telephone No. Aadhaar No. Email ID

Photo Mismatch Mismatch Sex PAN1: PAN2:

Request for cancellation of PAN(s)


Payment Mode
Net Banking: Your Payment of 96.00 against transaction number 401-354341 has been successfully processed. 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 voter's identity card Proof of Address: Copy of passport Proof of PAN: Copy of PAN card Proof of PAN to be cancelled: Any other document: Signature/Left Thumb Impression of Applicant (inside the box without touching the sides & in BLACK INK ONLY) Date: 14 - 08 - 2012

Service Tax Code (Registration Number): AAACN2082NST001 Service Tax Registration Category: BUSINESS AUXILIARY SERVICES



The above-mentioned 15-digit acknowledgment number is a unique reference number for your application for 'Request for New PAN Card or/and Changes or Correction in PAN Data'. Kindly quote this number for tracking the status of your application on 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 ( ) 96 Mode of payment Credit card / Debit card / Net Banking / Demand Draft (DD) payable at Mumbai/Cheque to be deposited in any HDFC bank branch across the country (except Dahej). DD payable at Mumbai

2 4.



Please mention name of applicant and acknowledgment number on the reverse of cheque/DD. Individual Applicants affix your recent colour photograph, sign the acknowledgment (inside the box provided without touching the sides and in BLACK INK only) and enclose a Demand Draft (DD)/Cheque, if any, alongwith Proof of Identity and Proof of Address as specified in the application form. Superscribe the envelope with 'APPLICATION FOR Change request PAN - Acknowledgment Number' (e.g., 'APPLICATION FOR Change request PAN - 881010200000973'). 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: 020-2721 8080; Fax: 0202721 8081. Your acknowledgment, DD 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. Applications without proof of PAN will be processed on a good effort basis - (as mentioned in guidelines).


8. 9. 10.