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Acknowledgement for request for new PAN card (Form 49A

)
ACKNOWLEDGEMENT NUMBER:

881020132449461

Citizen of India Y

Affix recent
photograph
(3.5cm x 2.5cm)

Signature/ Left Thumb
Impression across this
photo

Category

Individual

Name

Shri RANJITH VENKATACHALA

Affix recent
photograph
(3.5cm x 2.5cm)

Name to be
RANJITH VENKATACHALA
printed on card
Father's Name

Shri VENKATACHALA GUDATHIMMIAH

Date of Birth

04-09-1989

Residential
Address

667
7TH MAIN 11TH CROSS
BEL LAYOUT 1ST STAGE
BANGALORE - 560091
Karnataka

Office Address EAST WEST POLYTECHNIC
SY67
ANJANAGAR
BEL LAYOUT
BANGALORE - 560091
Karnataka
Address for
RESIDENTIAL
Communication
Telephone No.

91 9483232345

Email ID

RANJITH.V@LIVE.COM

AADHAAR No.

Payment Mode

Credit Card: Your Payment of ` 106 against transaction number 400-2224875 has been successfully processed.

I/We, Ranjith.v 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 Elector's photo identity card
Proof of Address: Copy of Elector's photo identity card
Proof of Date of birth: Copy of Matriculation certificate
Proof of Identity of representative assessee:
Proof of Address of representative assessee:
Any other document:

Date: 23-06-2015

Service Tax Code (Registration Number): AAACN2082NST001
Service Tax Registration Category: BUSINESS AUXILIARY SERVICES
CIN U72900MH1995PLC095642

(PLEASE READ INSTRUCTIONS GIVEN ON NEXT PAGE)

Signature/ Left Thumb Impression of Applicant
(inside the box without touching the sides and in BLACK INK ONLY)

Acknowledgement Number' (e.g. The acknowledgement number above is your unique reference number for PAN application. 6 Send the documents as specified in point no.5 cm). No. and proofs. Near Deep Bungalow Chowk. Survey No. Mantri Sterling. 3. 9 PAN card will be dispatched only to the communication address provided in your PAN application. Fax: 020-27218081. 4 Individual applicants affix your recent colour photograph (3. PAN card will be dispatched to the RA's address. should reach NSDL within 15 days from the date of online application. 341. if any. 4 above to Income Tax PAN Services Unit. 'APPLICATION FOR PAN 881010100000973'). 2 Save and print this acknowledgement. Application fee and mode of payment: Payment favouring 'NSDL-PAN' can be made as follows: Sr.5 cm x 2. sign the acknowledgement (inside the box provided without touching the sides and in BLACK INK only) and enclose a Demand Draft (DD). 2 Foreign 985 Credit card / Debit card / Demand Draft (DD) payable at Mumbai Mode of payment Please mention name of applicant and acknowledgement number on the reverse of cheque/DD. Kindly quote this number for tracking the status of your PAN application on https://tin-nsdl. Pune 411016 Tel: 020-27218080. Demand Draft if any. 997/8. Plot No. 7 Your acknowledgement. Proof of Address and Proof of Date of Birth as specified in the application form.com or any queries relating thereto. .14 in Form 49A ) are mentioned in the application. 5 Superscribe the envelope with 'APPLICATION FOR PAN . Address for Communication Amount payable ( ) 1 Indian 106 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). 8 Application will be processed only on receipt of relevant proofs and realisation of payment. 5th floor. alongwith Proof of Identity. Wherever the Representative Assessee (RA) details ( item no.Instructions: 1. Model Colony. NSDL e-Governance Infrastructure Limited.