Since the application is digitally signed using eSign/eKYC, there is no need to forward physical documents: Application for Allotment of Permanent Account {in the case of Indian Citizens/indian Companies/Entites incorporated in Indlal Unincorporated entities formed in india] Under section 129A ofthe Income Tax act. 1864 To avoid mistake s),please follow the accompanying instructions and examples before filing Assessing officer (AO code) Ainowldgerent Number N-eprosteaazseza | II [AREA CODE AO TPE ange Code | AONO lpT™ w u ° Sir, le hereby request that a permanent account number be allotted to melus. “SgRARTE CER TIRE TAVESSR We give below necessary particulars ‘Appcak (nade he box). 4. Full Name (Full expanded name to be mentioned as appearing In proof of identty/address documents: initials are not permitted) Please eelect tie, as applicable sn ‘smt ‘Kumari MS Last Name/Sumame BEART Firet Name KHUSHEOO Mice Name 2. Abbreviations of the above name, as you would Ike It, to be printed on the PAN card [KRUSHBOO BART 1 '3, Have you ever been known by other name? TD ves No Oosm OF sm OO kum OF wis Last NameiSurname Firat Name Mice Name 4. Gendertfor individual applicants only) Ota Ta Femaie LD tranegender ‘5. Date of Birthincorporation/Agreement/Partnership or Trust Deed/ Formation of Body of individuals or association of Persons Day Month Year foarosri9e2 {8 Detalla of Parents (applicable only for individual applicants) Wether mother isa single parent and you wish to apply for PAN by furnishing the name of your mother only? YesO no (lease tick as applicable) Iyes,please fllin mother's name in the appropriate space provided below. Fathers Name (Mandatory except where mother is @ single parent and PAN is eppied by furnishing the name of motner only) Last Name/Surname [prasaOSSC—“—sSSC“‘S*SsSY First Name [Ra Midala Name [CHANDRA "Mothers Name (Optionel except where mother a single parent and PAN is applied by furnishing the name af mother only) Lact Name/Suename First Name Mice Name Select the name of ether father or mother which you may lke fo be pied on PAN card (Sect one only) (ln case no option is provided then PAN card willbe issued with faners name) Fathers Name O Mothers Name (Please tick as applicable) (in case no option Is provided then PAN card will bé Issued with father’s name except where mother ls single parent and you wish to apply for PAN by furnishing name of mother only) 7. Address Residence Address Flat / Room / Door / Black ‘gramipo balsa ps parbatta Name of Premises / Bulding Basa Road Stroet/ Lane/Post Office ‘Area / Locality / Taluka! Sub Town / City District, Wegara ‘State Union Tamtory Pincods | Zip code County Name BIHAR ‘asia TOA Offices Address Name of office Flat / Room / Door / Block [Name of Premises / Building / Road | Strot/Lane/Post Office ‘Area / Locality / Taluka’ SubTown / Cy / District, State! Union Tertory Pincode / Zip code Country Name 8 Adress for Communication TA Residence Domes Please tick as appicable 9 Telephone Number & Ema ID detais Country code ‘Aree!STO Code Telephone / Mobile number a TESTEOTO, Emil KSHARTIOG2EGMAIL GOM 40._ Status of applicant Please select status, as applicable Ly Government TBI Iociual insu uncvidestamiy EQ Company TD Partnership Firm Association ot Persons DD twsts D1 body of ndvcuais LD Local Autnorty (Cj Artificial urdical Persons | Limited Liabilty Partnership ‘14, Registration Number (for company, firms, LLPs etc) 42, Incase ofa person, who Is required to quote Aedhaar number! the Enrolment ID of Aachaar application form as per section Please mention your AADHAAR number (if pecoooonas IH AADHAAR numbers no allotted, please mention the enrolment ID of Aedhaar application Name as per AADHAAR leitericard or as per the Enrolment 1D of Aadhaar application HUSHBOO BHARTI 49. Soures of income Qo Salary Business Profession {For Code. Refer instructions] i Capital on Incomes fom Business Income fom thor sources Ly tcome ro Huse propery 1 woncome 14 Representative Assessee (RA) Fullname, address of the Representative Assossoe, who is assessiblo under the Income Tax Actin respect ofthe parson, whose particu have been given in the column 1-13. Full Name (Full expanded name intial re not permitted) Pioaso select ito as appcablo Os OD st O kumi ms Lest Neme:Surname Fist Name Mice Name Addross Flat / Room / Door / Block [Name of Premises / Building / Road Stret/Lane/Post Office ‘Area / Locality! Taluka! Sub- Town / Cy District, State [Union Terry Pincode ‘Country Name 15. Documents submitted as Proof of kientty (POI), Proof of Address (POA) and Proof of Date of Birth (DOB) We have enclosed [AADHAAR Card issued by the Unque Identification Authonty of India as proof of identity [ADHAAR Card issued by te Unque Identicaton Autnonty of incie 25 proof of adcress and "RADAAAR Card ssuod by ihe Unique Mantiicahon Autionty oF iia os root otc oth (Pease relerto the mstuctons (as speciied in Rule 114 of Rules, 1962) or st of mandaiory certified documents o be submited es ‘appioable [Annexure A, Annexure B & Annexure C are to be used whecever aoplicable) 16 we [RHUSREOOBHARTT—] the appicant,in tho capacty of _[FiriselfHerse {do hereby dociare thal what fs staled sbove I True To he Best of your information and bole Proce WHARI DD MMW Date ‘aor0n2079 SHAR] LEE THRE SOT "Bopicant nse te box)