Form No. 45 Application for Allotment of Permanent Account Number ‘oa [in the case of Indian Citizens/indian Companies/Entites incorporated in India! oa tte, Unincorporated entities formed in india} ingests, oooh Seaman Detach ‘Ggene Sees 25am) Assessing officer (AO code) ‘Area code ‘AO type Range code RON. aad Si, UW hereby request that a permanent account umber be alloted to metus. We give below necessary particulars: ES 1 Full Name (Full expanded name to be mentioned as appearing in proof of identityaddress documents: initials are not permitted) Please select ito, | applicable Shei ‘Smt Kumari [| Last Name /Sumame First Nome Midtte Name 2 Abbreviations ofthe above name, as you would Tike R, nthe PAN card 3, Have you ever been known by any other na yes, please ove ta oer name Pease select tle, V/]as applicable Shi Smt Kumasi []oms No (please tick as applicable) Last Name Suame First Name ideo Name 4 Gender (for Individual applicants only) Mate Female [| Transgender (please tick 2s applicable) 5. Date of BirthIncorporation/AgreementPartnership or Trust Deed! Formation of Body of individuals or association of Persons Day Month ear {6 Details of Parents (applicable only for individual applicants) ‘nether matherfs'9 angle parent and you wish to apply fo PAN by furishing the name of your mother only? Yes|_| No[__ (pase as apliabe) It ye, please fil in mother's name inthe appropiate cpaco provided below. Fathor's Namo (Mandatory except whore mother is a single parent and PAN is appliod by furnishing the namo of mother only) Last Name / Sumame a a ave [nate Sonim an GF Tie Ta teaNane Sune Fra nae ee wagenome = LTT TTTITTTTITTITTtTittTiiiiity) Select the name of either fhe or meter which you may Ike tobe prinied on PAN card (Select one ony) Father's name Mathers name (Please tick a5 applicable) (incase no opin is provided then PAN card willbe issued with athe PAN by fmiehing name of the mother oni) 7 Address Residence Address Frat! Room Door / Block No. Name of Premises / Bung Vilage Roa Steet/Lane/Post Ofc ‘Area! Locality Taka Sub- Divison “own / Cy Distt Stat! Union Tertory Pincode ip ste Coury Name name excopt where mothers a single parent and you wish to apply for Office Address Semam — FREER Name of Premises / Buling ! Vilage Road / Steet Lane/Post Offce ‘Area Locally / Taluka! Sub- Division “Town / City | District State / Union Tortory Pincode | Zip code Country Name8 Adaress for Communication Residence Office (Please tick as applicable) 9 Telephone Number & Email ID details, County code AreaSTO Code “eepone/ Mobile number Email ID 10 Status of appicant Please select status, [7] as applicable 1 covernment Inaviual Hd undvides fami [] Company Partnership Fim [7 Associaton of Persons Twists Body of Individuals Local Auhorty Artic rica! Persons] Linited Labilty Partnership 111 Registration Number (for company, firms, LLPs ete.) 12 n Case of a person, who is required to quote Aadhaar number/The Enrolment ID of Aachaar application form as per section 139AA Please mention your AADHAAR number i altted) IAADHAAR number isnot alloted, please mention the enrolment ID of Aadhaar application frm Name as per AADHAAR lettericard or as per the Enrolment ID of Aadhaar application form 13. Source of Income Pease select, [¥] a8 applicable Salary Capital Gains Income from Business / Profession usiness/Profession code {For Code: Refer instructions) [_] Income from Other sources Income from Huse property No income 14 Representative Assessee (RA) Full name, address of the Representative A been given inthe column 1-13, 3806, who is assessible under the Income Tax Act n respect ofthe person, whose particulars have Full Name (Full expanded name : initials are not permitted) Please eolect ttle, |v Jos applicable shi set Kuma [ ]s Lest Name / Sumame First Name Midte Namo Address Flat | Room / Door / Block No, Name of Premises / Bung! Vilage Road / Street / Lane/Pest Office ‘Area / Locality! Taluka! Sub- Division TIT “Town City / District State Union Tertory Pincode 15 Documents submitted as Proof of Identity (POI), Proof of Address (POA) and Proof of Date of Birth (008) We have encloses ] 2s proof oridentiy, as proof of address and 2 proof of dato of bith [Pease refer tothe instructions (as specified in Rule 114 of LT. Rules, 1962) for Iist of mandatory certified documents to be submited as applicable] [Annexure A, Annexure B & Annexure Care tobe used wherever applicable] 16 Ie the applicant, inthe capacty of do hereby declare that what i ated above is true tothe best of my/our information and bali Place DoMMYYYY ‘Signature / Left Thumb impression of Applicant inse the box)