Form No.

49A
Application for Allotment of Permanent Account Number
[In the case of Indian Citizens/lndian Companies/Entities incorporated in India/ Only
Only
‘Individuals’ Unincorporated entities formed in India] ‘Individuals’
to affix récent See Rule 114 to affix recent
photograph photograph
To avoid mistake (s), please follow the accompanying instructions and examples before filling up the form (3.5 cm x
(3.5 cm x
2.5 cm) 2.5 cm)
Assessing officer (AO code)

Area code AO type Range code AO No.

Signature (OR) Left thumb
impression across this photo

Sir, I/We hereby request that a permanent account number be allotted to me/us.
I/We give below necessary particulars: Signature (OR) Left Thumb Impression

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 S I N G H

First Name S A N D E E P
Middle Name K U M A R
2 Abbreviations of the above name, as you would like it, to be printed on the PAN card

S A N D E E P S I N G H S I N G H

3 Have you ever been known by any other name? Yes ✔ No (please tick as applicable)
If yes, please give that other name
Please select title, as applicable Shri Smt. Kumari M/s

Last Name / Surname

First Name
Middle Name

4 Gender (for Individual applicants only) ✔ Male Female (please tick as applicable)
5 Date of Birth/Incorporation/Agreement/Partnership or Trust Deed/ Formation of Body of individuals or association of Persons
Day Month Year

12 0 1 1 9 9 6
6 Details of Parents (applicable only for individual applicants),
Father’s Name : (Mandatory, Even married women should fill in father’s name only)
Last Name / Surname S I N G H
First Name S H Y A M
Middle Name B A H A D U R
Mother’s Name (optional)
Last Name / Surname
First Name
Middle Name
Select the name of either father or mother which you may like to be printed on PAN card (select one only)
(In case no option is provided then PAN card will be Issued with father’s name)

7 Address
✔ Father’s name Mother’s Name (Please tick as applicable)

Residence Address
Flat / Room / Door / Block No. H o u s e n o 1 3 6 b l o c k a g a l i
Name of Premises / Building / Village N O 5 P O P N A G E R T I L P A T
Road / Street / Lane/Post Office F A R I D A B A D
Area / Locality / Taluka/ Sub- Division F A R I D A B A D
Town / City / District F A R I D A B A D
State / Union Territory Pincode / Zip code Country Name
HARYANA 1 2 1 0 0 3 INDIA
Office Address
Name of office P U S H P A K P R E S S P U T L T D
Flat / Room / Door / Block No. 2 0 3 . 2 0 4 O K H L A I N D U S T R I A L
Name of Premises / Building / Village A R E A P H A S E 1 N E W D E L H I
Road / Street / Lane/Post Office U N I O N B A N K O F I N D I A
Area / Locality / Taluka/ Sub- Division U N I O N B A N K O F I N D I A
Town / City / District A M B A L A
State / Union Territory Pincode / Zip code Country Name
DELHI 1 1 0 0 2 0 INDIA
8 Address for Communication ✔ Residence Office (Please tick as applicable)

9 Telephone Number & Email ID details

Country code Area/STD Code Telephone / Mobile number
9 1 9 3 5 4 8 9 8 5 8 8
Email ID sandeeprajput63666@gmail.com
10 Status of applicant
Please select status, P as applicable Government

✔ Individual Hindu undivided family Company Partnership Firm Association of Persons

Trusts Body of Individuals Local Authority Artificial Juridical Persons Limited Liability Partnership
11 Registration Number (for company, firms, LLPs etc.)

12 In Case of a person, who is required to quote Aadhaar number/The Enrolment ID of Aadhaar application form as per section 139AA
Please mention your AADHAAR number (if allotted) 6 8 4 6 8 1 3 1 5 8 9 2
If AADHAAR number is not allotted, please mention the enrolment ID of Aadhaar application form

Name as per AADHAAR letter/card or as per the Enrolment ID of Aadhaar application form

S A N D E E P K U M A R S I N G H

13 Source of Income Please select, as applicable

✔ Salary Capital Gains

Income from Business / Profession Business/Profession code [For Code: Refer instructions] Income from Other sources

Income from House property No income

14 Representative Assessee (RA)

Full name, address of the Representative Assessee, who is assessible under the Income Tax Act in respect of the person, whose particulars have
been given in the column 1-13.

Full Name (Full expanded name : initials are not permitted)

Please select title, as applicable Shri Smt. Kumari M/s

Last Name / Surname

First Name
Middle Name
Address
Flat / Room / Door / Block No.
Name of Premises / Building / Village
Road / Street / Lane/Post Office
Area / Locality / Taluka/ Sub- Division
Town / City / District
State / Union Territory Pincode
Tamil n

15 Documents submitted as Proof of Identity (POI), Proof of Address (POA) and Proof of Date of Birth (DOB)

I/We have enclosed Aadhaar card as proof of identity, Aadhaar card

as proof of address and Aadhar card as proof of date of birth.

[Please refer to the instructions (as specified in Rule 114 of I.T. Rules, 1962) for list of mandatory certified documents to be submitted as applicable]
[Annexure A, Annexure B & Annexure C are to be used wherever applicable]

16 I/We SANDEEP SINGH , the applicant, in the capacity of HIMSELF

do hereby declare that what is stated above is true to the best of my/our information and belief.

Place : FARIDABAD

D D M M Y Y Y Y
Date : 2 9 0 6 2 0 1 9
Signature (OR) Left Thumb Impression of Applicant (inside the box)
 Specimen copy for your Reference (Photograph and Sign) Below Instructions Is For Your Guidance Read Them Carefully

Application Page 01

Application Page 02

Do's Dont's

 Print Application in White A4 sheet only.  Do Not print in colour paper , One side paper.

 Affix two (same) RECENT COLOUR photographs.  Do Not affix STAMP size, OLD, Black & White photographs.

 Photos should be Straight Faced with Plain Background.  Photos should NOT be Side faced, Blur,Stapled or Pinned.

 Applicant or Representative Assessee should sign in BLACK  Do Not use Colour, Glitter, Sketch pen etc. Do not sign Multiple
INK pen only. Times in the given space for signature.

 Representative Assessee Should Sign on Behalf of MINOR.  Minor Should NOT Sign in Application Form.

 In case of Thumb impression it should be attested by  Thumb impression in application without attestation will not be
Gazetted Officer with Seal and Signature. accepted.

 ENCLOSE COMPLETE PROOF OF DOCUMENTS - First  Do Not Enclose Partial proof of Document ( i.e enclosing first /
Page, Second Page, Front Page, Back Page etc. front page of document) it will NOT BE ACCEPTED as proof.

Mandatory Documents: Send Signed Original Copy of Pan Application Form, Copy Of Aadhaar Card – If Aadhaar Number Allotted OR Copy of
Enrollment Id Of Aadhaar Application Form ( If Aadhaar Number Is Not Allotted )

Check List - As Applicable Enclose Complete & Legible Proof of Documents -1st & 2nd page of proofs to be Enclosed with the Application.

✔ Identity Proof:
Aadhaar card Office Address Proof

✔ Address Proof: *Representative Id proof :

Aadhaar card
✔ Date of Birth Proof: Aadhar card *Representative Address proof :

For Minor Applicant - Mandatory Documents : Send Original Copy of Pan Application Signed By Representative Assessee ( i.e Father / Mother /
Guardian ) Copy Of Minor DOB Proof Copy of Minor Aadhaar Card OR Minor Enrollment Id Of Aadhaar Application, RA Identity and Address Proof.