Copy to be kepi with application Tax invoice cum FTectrvoien core h- assroero ana ato. ay 2024 Category Pee | ‘Applicants are cer manan Tana Extating PAN [¥ROTECRIE { aoe ard [AEET KUMAR TaRAN - Fathers Name [RUENDRA KLAR TARAN a Mother's Name Net mentored 5 a Date of Binh’ oro nee [Communication Adress Site MADHYA PRADESH 23) Swen ataonmei2 Eman [ewwsseaonnn com root of kdenty [MOKAAR Carte te Unie MentnionAuhory fa Proof of Address [AADHAAR Carel byte Unive een Asony ora root ef boa [moran car ues ye Une Wereeatin aumory ean PAM application for wi.00 casTs% %.t0 eqns mc nN un RsD eak PADUA Ra Chana ‘scsTom 70.00Request For New PAN Card Ori And Changes Or Correction in PAN Data Permanent Account Number (PAS) Pslwlale it! ela f ISTP ‘Please reed insructions Wy & for selecting boxes on laf margin ofthis form. ‘Spat br ‘ame (Fllexpanced nares be mentonestas appearing in proororiaentmieaaress SOYA GANZ documents, inivais are not permitted), Please select ttle, [/ ]as applicable {_lewe [_|smt [| Kumari [}nws Larttiame/sumame [TRL cc T Co T FisiName Nek hl gw | ise Hare ‘iam Name you would le plied ona PAN cord FREE Ree A177 Details of Parents (applicable oniy forindividual applicants) Fathars Nerve (Mandatory, Even maried women should fil in LantNore/Sumame (FT ]BRTB, FirstName ADE Mcdle Nome [elo at Mothers Nan opin Lmiternersimene ST TTT FirstName t Mote Nome Pooe Stat he aro th ater or other wih you rey thet pnd on PAM carat one ai Ugcovenwepton prodded the AX cardia wht name) | Y]Etetame | ]Mothers Name Pas ck a scab) 77Soe ot snincorporn Dees Femation of Body of dts or Assocation of Parsons eee __ lt] fo) [ste] 27 Gender (for individual applicant only) \ [cama] Female (Peas tc as appa) mee Pa seman caren need Obs pu mieten ined nee a t Name of Premises! Building’Vilage | Road/Streat Lane/Post Offica I | | | ‘Arve ! Local Taluka / Sub- Divison i l Town / City / District P ‘Sai {Union Teentory Poste] Zipeade _ — Courliy Name L Mikouya Peaoesy —____T{{[{{Tt THEA eee Lo} you dese te update your other address also, ive reuire detail In additonal sheet {Ld Telephone Number & Es 0 setae Country cose Area/STD Cone ‘Teepnone | Mobile number Sal lsh Tet TT & t emto EmsSiat Sani aa {E71 anpniaat number lotes) RT es asloel —— FN) eis T +h + — Fermanent Account Nunbers (PAs) nr aboed tye i tae _Lpana{ tak JPAN S| i | Jean el TTT A the applicant, n the copacty of ido here doclore that what Ts tated shove ler fo the beat of mylour information and belie {We have enclosed) | numberof documents in suppor el propeted changes / correcta Pcs [| BHDPAL ee Doumy yy ome fol Sol sia) Tels