Date: 19032617 Narervav en Nuthwe « prea sisi pet Payment Status: Success Your Payment of Rs.107.00/- for one PAN Application has been accepted subject to realization and final settlement confirmation from your Banker. Please quote Reference No, 6043893118 for any future correspondence, Application number : U-NO01473237 Coupon number : U-NO01473237 ‘Aaseasing OficeriAO Gods) Area Como AO Tyre Range Code Aone [1. Full Name (Full expanded name: inftials aro not permitted): {Name / Surname = setName sumame = [evet nome rt ar Sete pom nan eo a car aS Have founean RaSenby any Serer [asthe Surne: Ra [Titte:- mrs ile Names a Gender:- [s.Date of Birth / Incorporation/AgreamentiParinarship or Trust Dead/Formation of [Body of Individuals/Association of Perso! (6. Father's Name :Last Name /Surname = l1o03'2017 [FirstName Mother's Name :|[Last Name /Surname :- [First Name: |The name of either father or mother which you may : like tobe printed on PAN card : FATHER'S NAME idle Name" jiddle Name: [7- Address: Residential Address: Flavboor/Block No Name of peat inghitage:- [WARP NO 22 RoadiStreevLanoiPost fortice: ‘ArealLocality/Toluke/Sub-| (OLDING NO 749 pancarazacloivision:- TownCity District: ‘StateiUnion PIN Gode:~ a 7 [CUTTACK [Territory:- ODISHA [753001 Coury: IDA. Official Adsroas™ Office Nam JS SANTOSH MEDICINES | FlatDoorfBiock Ne [HOLDING No 749 Name of fremivesrbutdrgraage. [ARO NO RodSireeutanoiPost Tuanoaiaac ArealLocality/Taluka/Sub-| vision: TTown/ciiyibistrct:= StatelUnion PIN Code : 9 (CUTTACK [Territory:- ODISHA_|l753001 Gountry:- INDIA e a ft. Address for [Communication:~ prace [B. Telephone Number & Emailid Details = Co a i ; lose" for [Brewer | a Ss 10. Status of the Applicant 7m _ [¥. Registration Numbor(for Kcompanystieme LP's ets)s- 2. Please Mention your AADHAAR Number allotted) Capital Gains [13.Source of income. SALARIED Income from Business/Profession Business/Profession code:- OTHERS. Income from Other sources ‘No income Income from House property person, wins aess ofthe Representative Assesses, whos aasoneabl under ihe icons ox AGW TSOSUA TS oon, whose particulars have been given Incobues ie te Tile: st Name [Wale Names Fretione= FiauDoorfSlock Nas= Name of [Promizes/Buikingvtage:- RoadiStreev-aneiPost ee ‘AroalLocaliy TanakaiSaa vison |L_TowniCity Distr [State/Union Territory ~_]PN Code:- [i Wwe have orelosed eae, MANORANJAN NISHRA ‘ne appicaatin th capacity of PARTNER ao HuaDy declare TIGR GIG? bovis rue tothe bost of my/our information sel veier ais a ‘ curtack orang Mire. relLatt thumb impression Place Date reek