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Appiieetion for Ailotr*ent of Permanent Account F-lumber

lhe case af lndian CitizensJln{tian e ompeniesif ntities ineorporated in lndial
Unincorporated ena:tigs fsri}led i;x hrdiai
Under section 139A of the lnccme Tax Aci. 13&'t
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Application Number: AO23408522

Coupon Number: AO7-34Oa522

PAN Card Mode:-

Boih-e+AN and ---__l
physical PAN Card I
Assessing Officer(Ao Code)
Area Code AO Type I
Ranqe Code AO No
KNP W 26 ,|

. Full Name name: initials are not

Abbreviation of the above name, as you would like it, to be printed on the pAN card:- SUNITA GODIYAL
Have been known by any other name? N

of Birth / lncorporation/AgreemenuPartnership or Trust Deed/Formation of Body

lndividuals/Association of Persons:-
of Parents (applicable only for indlvidual

mother is a and you wish to aDoly for PAN the name of vour mother onlv?

name of gither father or mother which you may

to be printed ofl PAN card i

7. Addressr
Residential Address:.
FlaUDoor/Block No.:- WARD NO 32
Name of Prcmises/Building/Village: - INDERPUR
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Road/StreeuLane/Post Off ice:- OFFICE BADRIPUR

Area/Locality/Taluka/Sub-Oivision:- BADRIPUR
Town/CityrDistrict- State/Union Terdtory:. Country:-
PIN Code:- 248006 INDIA
DEHRADUN UTTARAKHAND
OfficialAddress:.
Office Name:.
FlauDoor/Block No.:.
Name of PremiseslBuildinq/Villaqe:-
Road/StreeulanerPost Off icei-
Area/Locality/Ialuka/Sub-Division: -
To,rn/CityrDbtict- llStaletunionTerritory:- PIN Coder- llCountry:-
8, Address for Communication:- RESIDENCE

L Tebphone Number & Email lD Details :-

Country Area/STO Iele phone/lllobtle
Code:-
91
Code:-
g1
ilumber- aezssoozrolffiJlss:- 8hanu8979800210@gmail.com

10. Status of the ADplicant- lndividual

IL Reg istration Number(fo.
Company,firms,LLP's etc)i
12. ln case of a person,
who ie required to quote Aadhaar Number/ the
Enrolment lD of Aadhaar Application torm as per section 139AA
Please Meotion your ATADHAAR numbe(if
7056457717 43
alloted)
ItAadhaar number is not alloled, please
mention the enrolment lD of Aadhaar
apDlication folm
Name As per AADHAAR letterrcard or as pet
the Enrolment lD of Aadhsar application SUNITA GODIYAL
form

l3.Source of lncome
L saunteO n capital cains
L-.i lncome from BusinessrProfession [l lncome from other aources
[i lncome from House proporty No income

14. Full Name, address of the R6pr€sentativ€ Assassee, v{ho is asscasable under lhe lncome Tax Act in respect of tlle
po.son, whose particulars have been given in colmns'l to 13.
llLast Name:- Uiddle Name:- llFirst Name:-
FlaUDoorlBlock No.:-
Name of Premises/Buildinq,/Village:-
RoadlStreeuLane/Post Offi ca:.
ArealLocalityffaluka/Sub-Oivision: -
fown/City/District: - State/UnionTenttory:- llPlNCode:-

l,lwe have €nclosed A.ADHAAR Card issued by UIDAI (ln Copy) as Proof of ldentity , AADHAAR Card issued by
as Proof of Address and AADHAAR Card issued bv UIDAI (ln coov) as Proof of DoB,
l/We SUNITA GODIYAL ,the applicant,in the capacity of HIMSELF/HERSELF do hereby declare that what is stated
is true to the best of my/our information and belief.
DEHRADUN

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