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Permanent Account Number(PAN) Sign with black ball point pen within the below box
BQNPK6765L
Sir, I/We hereby request that a permament account number be alloted to me/us.
I/We give below necessary particulars:
☐ 1. Full Name (Full expanded name to be mentioned as appearing in proof of identity/address documents: initials are not
permitted)
Please select title, ☑ as applicable ☑ Shri ☐ Smt ☐ Kumari ☐ M/s
Last Name / Surname KUMAR
First Name SHIV
Middle Name
SHIV KUMAR
☐ 2. Father’s Name (Only ‘Individual’ applicants: Even married women should fill in father’s name only)
Last Name / Surname GOPAL
First Name KRISHAN
Middle Name
Name of office
☐ 8. If you desire to update your other address also, give required details In additional sheet.
☑ 9. Telephone Number & Email ID details
Country Code STD Code Telephone Mobile Number
91 9896785416
Email ID
shiv.arora89@gmail.com
☐ 10 AADHAAR number 222073136440
Name as per AADHAAR SHIV KUMAR
☐ 11. Mention other Permanent Account Numbers (PANs) inadvertently allotted to you
PAN1 PAN3
PAN2 PAN4
12. Verification
I/We SHIV KUMAR , the applicant, in the capacity of HIMSELF do hereby declare that Sign with black ball point pen within the below box
what is stated above is true to the best of my/our information and belief.I/We have
enclosed 1 (number of documents) in support of proposed changes/corrections
Documents to be attached
Date of birth in application form should match Income Tax Database. If DOB does not match the form will
be withheld
Date of birth in proof should match with the application. If DOB does not match the form will be withheld
APO