You are on page 1of 2

Affix recent

photograph
(3.5cm x 2.5cm)
Affix recent
photograph
(3.5cm x 2.5cm)
Signature/ Left Thumb
Impression across this
photo
ACKNOWLEDGEMENT NUMBER:
Category
Permanent
Account No.
Name to be
printed on card
Father's Name
Name
Other Address
Address for
Communication
Date of Birth
Telephone No.
AADHAAR No.
Email ID
BFZPG5128N
Shri ANKIT KUMAR GOYAL
ANKIT KUMAR GOYAL
Shri MUKESH GOYAL
01-02-1992
GOYAL VASTRALAYA
GANDHI BAZAR
VIJAYPUR
SHEOPUR - 476332
Madhya Pradesh
ANKIGOYAL.17@GMAIL.COM
979253769468
91 7566288710
Payment Mode
Net Banking: Your Payment of ` 105 against transaction number 401-1043034 has been successfully processed.
The following documents are enclosed as:
Proof of Identity:
Proof of Address:
Proof of PAN:
Proof of PAN to be cancelled:
Any other document:
Date:
Copy of AADHAR Card issued by the Unique Identification Authority of India
Copy of AADHAR Card issued by the Unique Identification Authority of India
Copy of PAN card
25-08-2014
Signature/ Left Thumb Impression of Applicant
(inside the box without touching the sides and in BLACK INK ONLY)
Service Tax Code (Registration Number): AAACN2082NST001
Service Tax Registration Category: BUSINESS AUXILIARY SERVICES
Individual
Photo Mismatch Signature Mismatch Sex
Request for cancellation of PAN(s)
PAN1: PAN2: PAN3: PAN4:
WARD 10
I/We, ANKIT KUMAR GOYAL the applicant, do hereby declare that what is stated above is true to the best of my/our information and belief.
(PLEASE READ INSTRUCTIONS GIVEN ON NEXT PAGE)
CIN U72900MH1995PLC095642
Proof of Date of birth: Copy of Matriculation certificate
881030214617512
Acknowledgement for Request for New PAN Card or/and Changes or Correction in PAN Data
Instructions:
The above-mentioned 15-digit acknowledgement 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
https://tin-nsdl.com or any queries relating thereto.
Save and print this acknowledgement.
Application fee and mode of payment: Payment favouring 'NSDL-PAN' can be made as follows:
Sr. No.
Address for
Communication
Amount payable
( )
Mode of payment
1 Indian 105
Credit card / Debit card/ Net Banking / Demand Draft (DD) payable at
Mumbai/Cheque to be deposited in any HDFC bank branch across the country
2 Foreign 971 Credit card / Debit card / DD payable at Mumbai
Please mention name of applicant and acknowledgement number on the reverse of cheque/DD.
Individual applicants affix your recent colour photograph (3.5 cm x 2.5 cm), sign the acknowledgement (inside the box provided
without touching the sides and in BLACK INK only) and enclose a Demand Draft (DD), if any, alongwith Proof of Identity, Proof of
Address and (Proof of Date of Birth - Indian citizens only) as specified in the application form.
Superscribe the envelope with 'APPLICATION FOR PAN - Acknowledgement Number' (e.g. 'APPLICATION FOR PAN -
881010100000973').
Send the documents as specified in point no. 4 above to Income Tax PAN Services Unit, NSDL e-Governance Infrastructure
Limited, 5th floor, Mantri Sterling, Plot No. 341, Survey No. 997/8, Model Colony, Near Deep Bungalow Chowk, Pune -411016
Tel: 020-27218080; Fax: 020-27218081.
Your acknowledgement, 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.
Applications without proof of PAN will be processed on a good effort basis - (as mentioned in guidelines).
6
9
5
3
4
2
8
1
7