Since the application is digitally signed using eSign/eKYC, there is no need to forward physical documents: Acknowledgement Naber N-esroaraserst4s | II Application for Allotment of Permanent Account [in the case of indian Citizensiindian Companies/Entities incorporated in Indlal Unincorporated entities formed in india] Under section 129A ofthe Income Tax act. 1864 ‘To avoid mistake 3), pleas follow the accompanying instructions and examples befor filing Assessing officer (AO code) [AREA CODE AO TPE Range Code [ AONO loue wx 7296 4 Sir, We hereby request that a permanent account number be allotted to me/us. ‘SgRORE LER TRIAS TWEESSN We give below necessary particulars ‘Appa (nade he box). 4. Full Name (Full expanded name to be mentioned as appearing in proof of identty/address documents: initials are not permitted) Please eelect tie, as applicable snr ‘smt ‘Kumar MS Last Name/Sumame KOTWART Firet Name RAJKUMAR Mice Name 2. Abbreviations of the above name, as you would lke I, to be printed on the PAN card [RAIKOMIAR KOTWANT 1 '3, Have you ever been known by ther name? OD ves No Oosm OF sm 0] kum OF wis ‘Last Name/Surname Firat Name Mice Name 4. Gendertfor individual applicants only) Bm TO Femaie LI tranagender ‘5. Date of Birthincorporation/Agreement/Partnership or Trust Deed/ Formation of Body of individuals or association of Persons Day Month Year foaroeri9e0 {8 Detalla of Parents (applicable only for individual applicants) Wether mother isa single parent and you wish to apply for PAN by furnishing the name of your mother only? YesQ no (lease tick as applicable) Iyes,please fllin mother's name in the appropriate space provided below. Fathers Name (Mandatory except where mother is @ single parent and PAN is epplie by furnishing the name of motner only) tat Novae cay Mothers Name (Optionel except where mother i a single parent and PAN is applied by furnishing the nme af mother only) Lact Name/Suename First Name Mice Name Select the name of ether father or mother which you may Ike fo be pnited on PAN card (Select one only) (ln case no option is provided then PAN card willbe issued vith fatners neme) Fathers Namo Mothers Name (Please tick as applicable) (in case no option Is provided then PAN card will bé Issued with father’s name except where mother le single parent and you wish to apply for PAN by furnishing name of mother only) 7. Address Residence Address Flat / Room / Door / Black ‘Se6Me UT Quateer Name of Premises / Bulding TP Nagar Aimer Road Stroet/ Lane/Post Office ‘Avea/ Locality / Taluka! Sub- Town / City / District ‘Aner ‘State Union Tamtory Pincade Zip code County Name RAJASTHAN 305007 TOA Office Address Name of ofice Flat / Room / Door / Black "Name of Premises / Building / Road | Strot/Lane/Post Office ‘Area Locality | Taluka! Sub-Town / Cty / District Stato / Union Tertory Pincade (Zipcode Country Name 8. Adress for Communication Bal Residence Done Plea tick as applicable Telephone Number & Ema ID details Country cove AreaiSTD Code Telephone / Mobile number i BOTT Emil OiOTSGAGGNAIL COM 40, ‘Status of applicant Please select status, 9s appoable Dy Covernmont Bal dividual pindu uncvidesfamiy EX] Company 1D Pornersio Finn 1 Associaton of Persons DF tnsts D1 Body of ndvicuais DD teal Autnorty Cj Artticial undies! Persons | Limited Lsbilty Parnership ‘14, Registration Number (for company, firms, LLPs etc) 42, Incase ofa person, who is required to quote Aedhaer number the Enrolment ID of Aachaar application form as per section Please mention your AADHAAR number (if pecooooxeae0 IH AADHAAR numbers no allotted, please mention the enrolment ID of Aedhaar application Name as per AADHAAR leitericard or as per the Enrolment 1D of Aadhaar application RAIKUNAR KOTWANT 19. Soures of income ose Dasma Petsson wc rea MIE Ey eume om ase posey 1 tonne 14 Representative Assessee (RA) Fullname, address of the Representative Assossoe, who is assessiblo under the Income Tax Actin respect ofthe parson, whose partcuits have been given in the eolumn 1-13. Full Name (Full expanded name ints re not permitted) Pioaso seloct ito as appcablo Os FO st O kumi us Lest Neme:Surname Fist Name Midie Name Addross Flat / Room / Door / Block "Name of Premises / Building / Road Stret/ Lane/Post Office ‘Area / Locality | Taluka! Sub- Town / City Distr State [Union Terry Pincode ‘Country Name 15. Documents submitted as Proof of kientty (POI), Proof of Address (POA) and Proof of Date of Birth (DOB) We have enclosed [AADHAAR Card issued by the Ungque Identification Authonty of nda ‘as proof of identity [AADHAAR Card ssued by the Unique Identicaton Autnonty of incie 25 proof of adcress and "RADFAAR Card ssuod by ihe Unique Mantiicahon Aumony oF ida os root otc oth (Pease referto tre mstuctons (as speciied in Rule 114 of Rules, 1962) for st of mandaiory cerified documents o be submited es ‘applicable [Annexure A, Annexure B & Annexure C are to be used whecever aoplicabe) 16 we [RAIKUMARKOTWANT—] the applecant, inthe capacity of __[FiriselfHerse {do hereby declare thal what fs staled sbove Is Tue To he Best of my/our information and bole Proce AER DD MM YW Date T20a2o7O. SHAW] LER THORS SST ‘Bosca inside te box)