Form No. 498 Application for Allotment of Permanent Account Number ‘i lin the case of indian CitizensiIndian CompaniesiEntities incorporated in Indial on indo Unincorporated entitios formed in India] nda toarreeet ‘Seo Rul 114 Seopa roan ‘Toad att (6) eee ow fw szopaning nssen anders eee lng phe tr eae a ‘Assessing officer (AO code) ‘Area code ‘AO type: Range code ‘AO No, Sir UWe hereby request that a permanent account number be altted to melus. We gWve below necessary particulars: ‘Staats reason 1 Full Name (Full expanded name to be mentioned as appearing in proof of identity/date of birth/address documents: initials are not permitted) Proase select to, [Vas applicable hi [smu Kuma [jams Last Name J Sumame First Name Midie Name 2 Abbreviations of the above name, as you would like it, to be printed on the PAN card 3. Have you ever been known by any other name? Yes No {please tick as applicable) yes, esse ge hat oe ame Please selec ite, [¥]as apptcabie [~] sha js. [T]kumai [Jans Last Name /Sumame FirstName Midde Name 4 Gender (for Individual applicants only) [_| Male Female ‘Transgender (please tick 2s applicable) '5 Dato of Birtvincorporation/AgroomentPartnership or Trust Deed/ Formation of Body of indvidualsor Association of Persons Day Month Year {6 Details of Parents (applicable only for individual applicants) ‘Whether mother isa single parent and you wish to apply for PAN by furnishing the name of your mother only? ‘yes |] No (please tick as applicabie) Ifyes, please fil in mother's name in the appropriate space provide below. Father's Name (Mandatory except where mother is a single parent and PAN Is applied by furnishing the name of mother only) Last Name J Suname First Name Midse Name ‘Mother's Name (optional except where mother is a single parent and PAN is applied by furnishing the name of mother only) Last Name J Sumame First Name Middie Name ‘Select the name of eter father or mother which you may ike to be prinled on PAN card (Select ane oni) Fathers name Mother's name (Please ick as applicable) (ln case no option is provided then PAN card wil be issued with father's name except where mother Isa single parent and you wish to apply for PAN. by fumishing name of the mother ony 7 Address Residence Address Fat! Room / Door! Block No. "Name of Premises / Bulking / Vilage Road / Street /Lane!Post Ofice ‘Ara / Locality Taluka! Sub- Division ‘Town / City Disiet, ‘Stale / Union Tertory Pincode /Zip code Country Name10 " 2 0 Office Address Name of ooo Flat Room / Door! Block No. Name of Premises / Bulking / Vilage Road / Steet / Lane!Post Ofce ‘ea / Locality Taluka! Sub Dvision Town / City / District, Stato Union Tertory Pincode !Zip code Country Name ‘Address for Communication Residence Office (Please tick as applicable) Telephone Number & Email ID details Country code ArearSTD Code Telephone | Mobile numer Emat ID Status of applicant Please solct status, [¥/] as applicable [1] covenant vial Hindu unvdedtamty [Company Parership Fm [J Ascosiation a Persons Trusts Body of ndvcuole Loca Authorty Afi! Juridical Persone [] Lined Liabity Partnership Registration Number (or company, firms, LLf In case of a person, who is required to quote Aachaar ‘number or the Enrolment 1D of Aadhaar application form as per section 139 AA Please mention your ARDHAAR number (f alloted) MAADHAAR number s no alloted, please mention the en‘aiment 1D of Aadhaar appicalion form [Name as per AADHAAR latter 6 card Oras per the Enrciment 1D of Redhaar application form Source of income Salary Income from Business /Profession _Business/Profes Income from House property 4 18 16 Representative Assessee (RA) Full name, address ofthe Ropresentative Assossee, who been given inthe column 1-13, Full Name (Full expanded name: initials are not permitted) Pease select |v] a8 apoeable Capital Gains sion code |For Code: Refer instructions) [__] income trom Other sources No income is assessible under the Income Tax Actin respact ofthe person, whose particulars have Please select ttle, [VJs appkcable she sm. Kuma [ |Mis Last Name / Surname First Name Mido Name adores Fat / Room / Door / Block No. Name of Premises | Builing | Vilage Road / Stoet/ Lane/Post Office ‘Area! Locality! Talukal Sub- Division Town / ity / Distict ‘State / Union Tertory Pincode Documents submitted as Proof of Identity (PO), Proof of Address (POA) and Proof of Date of Birth (POB) Wwe have reo [dab eatin, Sd Remeron as proof of address and [Please refer to the insirucions (as spedtiod in Rule 114 of as proof of date of bith "Rates, 1662) frist of mandatory certfed documents tobe submitted as applicable) [Annenue A, Annexure B & Annexure C ar tobe used wherever applicable] uwe| do heraby declare that what le elated above fs tue fo the beet of mylour information and belie. tn appa he capt of [——____} Place DOMMYYyYY Date “Sarature/ Leh Thum impression oF “Appcant (ne ha box)