Form No. 49a Appian fr Alain of Permanent Account Number ow tothe cae olin izanfnien CompanefEnties Incorporated inn ow ri ‘Unincorporated one ered aa ts ane arnt Po cca Assessing officer (AO code) a feacage | AO wpe | Range coos AON: woreee=|le [eo [> be [wl [el fe [s Si lo give below necessary particulars: 41. Full Name (Full expanded name to be mentioned as appearing In proof of fe hereby request that @ permanent account number be alloted to melus. Preaco sles We, [¥ Jos appliabio. shi [sm Kuma] nUty/date of brthiaddress documents: Intlals are not permitted) Last Name / Suiname Fist Name Miele Name 2. Abbreviations of the above name, 5 you would like it, tobe printed on the PAN card 3. Have you ever boon known by any tyes, please eho hat ther nama other name? vos [VJ No Please select ile, V/]as applicable shi sm Kuma []aus Last Name / Sumame First Name Midele Name {please tick as applicable) 4 Gender (for Individual applicants only) Mate Female ‘Transgender Date of Birth/incorporation/Agreement/Partnership or Trust Deed! Formation of Body of individuals or Association of Persons Dey Month Year 6 Details of Parents (applicable only Yes [7] No (piease tick 2s app LT] C1) CITT) for individual applicants) cable) yes, please fill mothers name inthe appropriate space provide bolow. Father's Name (Mandatory except where mother Isa single paront and PAN Is applied by furnishing the name of mother only) Last Name / Sumame First Narne Midele 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 / Sumame First Name Midele Name ‘Selec the name of either father or mother whi ‘v] Fathers name Mother {In case no option is provided then PAN card wil be issued with father's name except where mothers as by furnishing name ofthe mother ony) 7 Address Residence Address Fiat Room / Door / Block No, Name of Premises! Bulding Village Road / Street LanePost Office ‘rea Locality Taluka! Sub Division ‘Town/City / District, ‘Sate [Union Teritory {please tlek as applicable) Whether mothers single parent and you wish to apply for PAN by furnishing the name of your mother only? rsname (Please tick as applicable) Gh you may Ike To be printod on PAN card (Select ane only), ingle parent and you wish to apply for PAN cleft e{ae fr Blult|oaly fa Pincode / Zp code Country Name MAHARASHTRA 4 Pell INDIAOffice Addross Name of ofce Flat Room / Door Block No. Name of Premises / Building / Village Road / Set / Lane Post Office ‘ea / Locality Taluka! Sub- Division Town / ity /Distlet, ‘Slate! Union Terttory Pincode /Zp cade Country Name ‘Address for Communication ¥ | Residence Office (lease tick as applicable) Telephone Number & Email ID details Country code Area/STD Code Telephone / Mobile number opi ‘Status of applicant Please select status, [V/]as applicable Goverment Assoctation of Persons. ~]tnaividuat Hindu undivided family Company Partnership Frm ss Boy of Indus Local Aubonty ruc Jurca! Persons [[] Lined Laity Parnersip Registration Numbor (or company, fms, LLPs etc) In case of a person, who is required to quote Aadhaar number or the Enrolment ID of Aadhaar application form as per section 139 AA Please mention your AADHAAR number (alloted) ITAADHAAR number is no allotted, please mention he enrolment D of Aadhaar application tom Name as per AADHAAR letter Or card or as por tho Enroiment 1D of Aadhaar application form ES aoe eeect |v] os opoleable salay Capi eins Income from Business / Profession _Business/Profession code [For Code: Refer instructions} |v“ Income from Other sources: 1] inom rom House property [1] io tname Representative Assessee (RA) Full name, address of the Representative Assessee, who is assessible under the Income Tax Ac in respect ofthe person, whose particulars have been given in the column 1-13, Full Name (Full expanded name : initials are not permitted) Please select ite, [V ]as applicable Shi Smt Kumari [J Mis Last Name / Sumame Fist Name Middle Name Address Flat / Room Door Block No. Name of Promises / Building / Village Road / Street /LaneiPost Office ‘roa! Locality /Taluka/ Sub- Division Town | Gly District ‘State Union Tertory Pincode Documents submitted as Proof of Identity (PO)), Proof of Address (POA) and Proof of Date of Birth (POB) Ie hve ersed st fey as proof af address and as proof of date of bith [Prease rer to the instructons (as spaced in Rule 114 OTT. Rules, 1862} fr list of mandatory certited documents tebe submitted as applicable] [Annexure A, Annenute 8 & Annexure C are tobe used wherever applicable] wel]. the applicant, in the capacty of [_HiMT HER SELF] do hereby dalaro hat what seated above Te up o he best of myiour information and belt. Place ‘caIKLE DESDE Rane vanianian “Sipaiure/ Lat Thar nprasson of Date afo [i ‘Appear (se te box)