11117n019 https://www.myutiitsl.con/panonlineservices/addPanAppForm.

action

r Allotment of Fermanent Aeccunt Nurnber

rensllndian CampanieslEntities incorporated in lndial
orporated entities formed in lndiaS
:tion 13!,q cf the lncome Tax Aet. '1961

Datei 1711112019
VIeID:- 627411450016
Print

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Application Numberi AO253 19691 8^^at'19

Coupon Number: AO25319591

Both e-PAN and

PAN Card Mode:-
physical PAN Card
Assessing Officer(Ao Code)
Area Code AO Type Range Code AO No
NWR w 60 1

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

Iitle:- sHRl llLast Name:- SINGH Middle Name:. irst Name:- RAGHBIR
Abbreviation of tho above name, as you would like it, to be printed on the PAN card:- RAGHBIR SINGH
, Have you been known by any other name? N
llLast Name:- ddle Name:- irst Name:-
4. Gender:- MALE
5.Date of Birth / Incorporation/AgreemenuPartnership or Trust Deed/Fomation o,
Body of lndividuals/Association of Persons:- llroornnr''
6.Details of Parents (applicable only for individual
applicants),
r mother is a sin e parenta and you wish to apply for PAN by furnishing the name of ur mother onl

No,
6. Father' Name : Last Name:- SINGH Middle Name:- llFirstName:- GURBAKSH
The name of either {ather or mother which you may
E R'S N A M E
like to be printed on PAN card :

. Address:-
Residential Address:.
FlaUDoor/Block No.:- llH No e5
Name of Premises/Building/village:- BIR BADALWA
Road/StreeULane/Post Off ice: - GDHU
Area/Locality/Talukarsub-Division:- LOKHERI
Town/City/Oistrictr nion Territory:- lN Code:- 132157 ountryr INDIA

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11t1712019 https://www.myutiitsl.com/panonlineservices/addPanAppForm action

KARNAL ARYANA
Official Address:-
Office Name:-
FlaUDoor/Block No.:-
Name of Premises/Buildingi/Village:-
RoadrStreeULane/Post Off ice:-
Area/Locality/Taluka/Sub-Division :-
TownlCity/District:- Union Territory:- PIN Code:- ountry:-
- Address for Communication:- SIDENCE

. Telephone Number & Email lD Details :-

Country llarea/STD Telephone/Mobile Email
9't 0't745 8307927691 krishanrekhaST@gmail.com
Code:- Ilcoa",- Number:. Address:-
0. Status of the Applicant:- lndividual
11. Registration Number(for
Company,firms,LLP's etc):-
2. ln case of a person, who is required to quote Aadhaar Number/ the
rolment lD of Aadhaar ApPlication form as per section 139AA
Mention your AADHAAR number(if 9215801276
lloted)
lf Aadhaar number is not alloted, please
mention the enrolment lD of Aadhaar
pplication form
Name As per AADHA.AR letter,/card or as
the Enrolment lD of Aadhaar RAGHBIR SINGH
plication form

'l3.Source of Income

SALARIED capital Gains

lncome from Business/Profession lncome from Other sources

lncome from House property No income

14, Full Name. address of the Representative Assessee, who is assessable under the lncome Tax Act in respect of the
rson, whose p articulars have been given in colmns 1 to 13.
HRI Last Namer SINGH iddle Name:- Name:- RAGHBIR
lat/Door/Block No.:- HNO95
ame of Premises/BuildingA/illage:- BIR BADALWA
/StreeuLane/Post Off ice: - DHU
a/Local /Taluka/Sub-Division :- ILOKHERI
State/Union Territory:- PIN Code:- 132157
ownrCityrDistrict:- KARNAL HARYANA

15. l,/We have enclosed AADHA/AR Card issued by UIDAI (ln Copy) as Proof of ldentity , AADHAAR Card iss ued by
UIDAI ln Copy) as Proof ofAddress and AAD HAAR Card issued by UIDAI ln Copy) as Proof of DOB,
16. UWe RAGHBIR SINGH ,the applicant,in the capacity of HIMSELFIHE RSELF do hereby declare that what is stated
ove is true to the best of my,/our information and belief.

KARNAL tt1u\,-or9 p++$ri9z''

Signatuie/Left thumb impression of
Place Date
the applicant

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Raghbir Singh
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6192 1 580 1276

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6192 1 580 't276

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