Copy to be kept with application

Tax Invoice cum Acknowledgement receipt of PAN Application (Form 49A)

Tax Invoice cum Date- 10 Feb 2021
N - 232799701982433
Acknowledgement

Category INDIVIDUAL GSTIN of Applicant NA

Applicant's Name RAMMOHAN VNKATESAN SUJITH SURIYA

Name on Card SUJITH SURIYA V R

Father’s Name RAMMOHAN

Mother’s Name Not mentioned

Date of Birth/ 20 Mar 2002 Communication Address State TAMILNADU (33)

Telephone/ Mobile 091-9171179717 E-mail ID SUJRAMMOHAN2002@GMAIL.COM

Proof of Identity AADHAAR Card issued by the Unique Identification Authority of India

Proof of Address AADHAAR Card issued by the Unique Identification Authority of India

Proof of DOB AADHAAR Card issued by the Unique Identification Authority of India

On behalf of NSDL e-Governance Infrastructure Limited (PAN-Centre Managed by NSDL)

PAN application fee `91.00
Branch ID: 23279 SGST 9% `0.00
Integrated Data Management Services Private Limited
CGST 9% `0.00
C/O. I - NET SECURE LABS PVT.LTD 1045/527, GANTEC BUILDING, 2ND F ARUMBAKKAM
CHENNAI TAMIL NADU 600106 IGST 18% `16.38

Total(Rounded Off) `107.00

GSTIN:27AAACN2082N1Z8 CIN: U72900MH1995PLC095642 SAC : 998319

This is a computer generated receipt and does not require signature. Online PAAM 1.2

Applicant's Copy
Tax Invoice cum Acknowledgement receipt of PAN Application (Form 49A)
Tax Invoice cum N - 232799701982433 Date- 10 Feb 2021
Acknowledgement

Category INDIVIDUAL GSTIN of Applicant NA

Applicant's Name RAMMOHAN VNKATESAN SUJITH SURIYA

Name on Card SUJITH SURIYA V R

Father’s Name RAMMOHAN

Mother’s Name Not mentioned

Date of Birth/ 20 Mar 2002 Communication Address State TAMILNADU (33)

Telephone/ Mobile 091-9171179717 E-mail ID SUJRAMMOHAN2002@GMAIL.COM

Proof of Identity AADHAAR Card issued by the Unique Identification Authority of India

Proof of Address AADHAAR Card issued by the Unique Identification Authority of India

Proof of DOB AADHAAR Card issued by the Unique Identification Authority of India
On behalf of NSDL e-Governance Infrastructure Limited (PAN-Centre Managed by NSDL)
PAN application fee `91.00
Branch ID: 23279 Integrated Data Management Services Private Limited
C/O. I - NET SECURE LABS PVT.LTD 1045/527, GANTEC BUILDING, 2ND F ARUMBAKKAM CHENNAI TAMIL NADU 600106 CGST 9% `0.00
SGST 9% `0.00
IGST 18% `16.38
Note:- “As per instruction from Income Tax Department, an authorized agencies’ agent may visit you for your identity and address
verification as per the documents submitted by you with the PAN application form. You are requested to ask authorization letter/ID
card from the agent before verification. Your cooperation is solicited in this regard.” Total(Rounded Off) `107.00
GSTIN:27AAACN2082N1Z8 CIN: U72900MH1995PLC095642 SAC : 998319
For queries and information please contact: PAN/TDS Call Centers
020 - 27218080 020 - 27218081 tininfo@nsdl.co.in @NSDLeGovernance
Income Tax PAN Services Unit (Managed by NSDL)
5th floor, Mantri Sterling, Plot No. 341, Survey No. 997/8, Model Colony, Near Deep Bungalow Chowk, Pune – 411 016
If mobile no. is mentioned then you will receive SMS on status of your application.
You may track the status of your application using SMS facility – Type NSDLPAN<space>15 digit acknowledgement no. and send it to 57575 or by visiting our
website www.tin-nsdl.com.
You are also requested to provide feedback on your experience of PAN service at www.cleanmoney.gov.in
This is a computer generated receipt and does not require signature.
Online PAAM 1.2
 Form No. 49A
Applicalion for Allotment ot Pennanent Account Number
Un th6 case oflndian cilizensrlndian Companies/Entities incorporated in lndia/
tlnincorpotated eBtitiet form€d in lndial
Sss Rule t1lt
-ro
ahid mBiake 13), pl.e foll lhe a@omp6nyng insrudron6 8nd eramd6 betoB filling !p th6 aom

Asaessing offlcer (AO code)

AO type Range code AO No.

c ll E 3 ! I

hereby requestthat a permanent accol/nt number be allotted to me/us V.e. QJd4f/, Qu^^,\'e-
signalure / Len Thumb lmpression
l/vve give below nocessary partlculars:
\t+' ,l Full Name (Full expanded name to be mentioned as appearing in proof of identity/date of birlh/eddress docuftents: inilials are nol permitted)

Please select tifle, applicable Shri Smt. Kumai

E]as
q t) ':7 T T t.l eI ti P
.r Y R
tl
Last Name / Sumame

First Name at A, 14 N t) l1 R U
I
I

Middle Name V E 1,1 k B E C B N T I

2 Abb.eviations ot the above name, a! you would lik6 it, to be printed on the PAN catd
q 1' T '11 T +l ) U K :f v A p,

3 Have you ev€I been known by any other hame?

lfyes, please give lhat other name
E "* M-t" (please tick as applicable)

fr
Please select tille, as applicable Shri Sml. Kumari
E
Last Name / Sumame f II
First Name ll I

Middle Name

,l Gender (for lndividual applicants only) pl r,r"r' Female Tlansg6ndet (please tick as applicable)

S Date of Biith/lncorporation/Agreement/Paatnership or Trust Deed/ Formation of Body of individuals or Assoclalion of Persons

Day Month Year
g\
a D o 2 b t)
6 D6tails of Parenls {.pplicable only for indlvidual appllcants)
Whether mother is a single parent and you wish to apply for PAN byfurnishing the name of your mother only?

f ]ves l_]7Jruo lotease tick as applicable)

lf yes, please fill in molher's name in the appropdate space provide bel
Father's Nam€ (luandatory excePt where mother is a single parent arld PAN is applied byfumishing thc name oI molher only)
Last Name / Sumame 1{ A M M t) t-+ A N
First Name
I\Iiddle Name
f{other's Name (opti onal except urhere mother is a single parent and PAN is applied by turnishing the name of mother only)
Last Name / Surname

First Name
Middle Name
Solect the name of either father or molher which you may like to be printod on PAN card (Se/eci ore orl,
ffi Frth"r'" n"r" Mother's name
(Please tick as applicable)

(ln case no option is provided then PAN card will be issued with fathefs name except where mother is a single parent and you wish to apply for PAN
by fumishing name oftho motheronly)'
7 Addre6s
Resldence Address
Flat / Room / Door / Block No. t CN

Name of Premises / Building /Village

q R T N T) t"t l A N .rt R ? T) F t\
.T
Road / steet / Lane/Post Offlce k l) M )., o T I T .rl
'T
fuea / Locality / Taluka/ Su Division k 0 N N A h t) aI ( r-l
Town/CitylOisrict 5 A at
State / Union Territory Pincode / Zip mde CounW Name
-TEM'I LNFbU Alc A o blR
.r:N Df. A
 Office Addre6s
Name of office

Flat / Room / Door i Block No.

IIII
IITTIIIIIIIIII ITITIIIIIIIIItr
Name of Premises / Building / Village IIIIIIIIIIIIIIII
IIIIIITIIIIIIIII
Road / Street / Lane/Post Office
Area / Locality / Taluka/ Sub- Dvision IIIIIIIIIIII IIIIIIIII
Town/City/District
State / Union Territory
IIIITII IITI
Pincode / Zip cod€ Country Name

IIIIIII
8
9
Addrssa for Communication
Telephone Number & Email lD details
V Residence Office (Pleass tlck as applicable)

Country code Area/STD Code Telephone / l\,4obile number

Email lD
+ a tl IIIII llq
Sui'rnrnrnohon .!oo& /D 9ne,,ir.
I l- l -7 q
c-c, m
l i 1
l0 Status ofapplicant
Please select status,
Z as applicable Government

V lndividual Hindu undivided family

tr Company tr Partnership Firm Association of Persons
Trusts Body of lndividuals
tr LocalAuthority tr Arlifi cial Juridical Persons Limited Liability Partnership
'l I
m
Regi$lrstion Number (for company, tirms, LLPS etc.)

12 ln case of a person, who is requlred to quote Aadhaar number or the Enrolment

i

lD
I |llll
ofAadhaa. application form as per section 139 AA
Please mention yoUTAADHAAR numbor (if allotted) q I1 x o 3 I I D Z )
IfAADHAAR number is not allotted, please mention the enrolment lD ofAadhaar a ication form

Name as peTAADHAAR letter or card or as r the Enrolment lD ofAadhaar ication form

I III
) 0
ITL I I T
m ] T_ IIIITIIIIII
H
C
., U R. v R I
-TT-T_IT-I-T_ +
13 Source of lnqome Please select, V as applicable

II Salary
lncome from Business / Profession Business/Profession code [For Code: Refer instructions]
Capital Gains
lncome from Other sources

I lncome from House property

14 Representative Assessee (RA)
V No income

Full name, address of the Representative Assessee, who is assessible under the Income Tax Act in respect of the person, whose particulars have
been given in the column '1-13.
Full Name (Full expanded name : Initial8 are not pemitled)
Please select title,
Last Name / Sumame
as applicable Shri

IIIIIII
Smt.
-l Kumari

First Name
[Iiddle Name
fT_T_T_rT_r
ITIIIIIIIIIIIT IIIT
Address
Flat / Room / Door / Block No.
Name of Premises / Building / Village
IIII]EI
IIIIIIIIIIIIII It] I=T t-
Road / Street / Lane/Post Office
TIIIIIIIIIIIII
ITIITI
Area / Locality / Taluka/ Sub- Division

TownlCity/District
IITTITITITI
IIIIIIIIIIIIII
State / Union Territory Pincode

15 Documents submltted as Proof of ldentity (POl), Proof ofAddress (POA) and Proof of Date of Blrth (POB)
l/We have enclosed AAT) }+A a as proof of identity, I RR:D HCR
as proof of address and AEDHTT? as proof of date of birth
lPlease refer to the inst uctions (as specified in Rule '114 of l.T. Rules, 1962) for list of mandatory certified documents to be submitted as applicablel
[Annexure A, Annexure B & Annexure C are to be used wherever applicable]
16 l/vve , the applicant, in the capacity of utM.qtr )--F
do hereby declare thai whal is stated a is kue to lhe best of my/our iniormalion and belief.

Place :
V.R fu-rr-iftv Gw'Lr.
D DM M Y YY Y Signature / Left Thumb lmpression of
Date bq o s t Applicant (inside the box)
 ffi*
$.\ aflkl t{{+tt A'
'SITIITT
Unique ldentification Authonty of lndia
Govemment of lndia

,dca,, O 5r5l",/En ro ment No.:204 3/50639/06169

Suriya V R (es|e 1afflrr P&o'6i)

o Sujith
A)
oir art)
tl .2;pr ri elarL 'd,6dnrrJ Lrrir31, ,.r,q uJii6Drr; r, ef i'd'
S/O: Rammohan, i 2, BRINDHAVAN GARDEN, ',,
-.1 KOMBAIPATT l, KANNANKURICHI, Salem, I e1o, orr"rr airirop €r6ir6,6t5ir.?ry',6i,,1GJ,$l.!;r Ui6rrrJr,r r 'l!pr1ri
Tamil Nadu - 636008 I @5 orr'i,Irroi;6.10,6irrr6,, iy,,-','r.,unfia ttt I rtt),t!t tit
N
6g,lrirt: Orrptrl,.;i ,5 15 arurprl5rlGu:6r r r€x,Iair :i.i
Lj,asir €ptrri oralr/ Your Aadhaar No.: ,rr:,r,ri',, i,J,6, )t:'.4tir ti)rtt:.),L6r

9780 1321 1033 INFORMAT ION

a Aadhaar is a proof of identity, not of cltizenship.

a To establlsh identity, authenticate on ine.
a This is electronically generated letter.

Note: Children on attaining '15 years of age need to

update [iddletriEmrmat io n.
o qE,y ,6d 6, D/L 10uE
OENT F CAT O!AC{HOi t DF A^]
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a .Zbrti pro (9)(q6rpt9]l; 6l&6irg2juL1urr(,rb. a_Aadhaar is va id throughout the counhy.

J .e1gpn ti lyprn GrLorargpg gGr t-(5 gr6DI, rru@Co f&,,i a You need 10 enroi ony once forAadhaar.
or5rn6!r,Lr'$oop t4ibjt coib! ue'q ?a jtu GoarLe u a Please updale your mobile number and e-mail address.
€lorilurLb 6rp)r6rri. This will help you to avail various seruices in luture
a 9u646siig Ltsts,fr)6,n eL $6apur rtriur 6lLcx6DLr6-n itLbun
rppi e-6ltorn6i grrrorrl]erru rlpiq C,'rru,oJb. Oparr6n
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6l.r6lrl,f urb dil5i]r i;6Ji.

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A\ cn*q frRrE fiqH
UNIOUE IOEN!TNA1DN AU'IHOF] Ti, OF I]1]Ii,
fl'fr-6{rrr
ET GOVERNMENT OF INDIA

iter6 s',frl:.,,r o? .erJi gr a. er rfi: Address:

SIO Rammohan. l?.
Sujith Suriya V R ,!!.r..\ l! i)6,tttl 6RINOHAVAN GARDEN,
tlpgg yrsnl OOB: 20 10312002 linGr t nl 12. KO MAAIPATTI,

q6oin / MALE il155r,rrr"n r,r'ir ;ir KANNANKUR CH]. Sa enT

Tatr lNadu 636008

.i,;iror 11i i;t. ir.r'i

ir

;r,irl 1r@ - 636003

9780 1321 1 033 9780 1321 1033

oewgt q6pr ri , e t etrg; g4eouurnenrb. IVERA AADHAAR. IVERI PEHACHAN