Application Number: U-N004946921

Application Number Bar Code Payment Reference: WHMP0357559403 Inward Number Bar Code
Payment Date: 2021-10-21 16:06:20.0 Rs.106.90/-
Application Source: UTIITSL WEB-SITE Application Date: 21/10/2021
User Id: INTERNET USER User Name: INTERNET USER
PAN CARD MODE : Both physical PAN and e-PAN Card Application Mode : Digital Application (e-KYC)

P N E W 7 0 1

eKYC-Application

✘
W A G H O O
N I K H A T P A R V E E N
S I R A J

N I K H A T P A R V E E N S W A G H O O

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Whether mother is a single parent and you wish to apply for PAN by furnishing the name of your mother only? Yes No ✘ (please tick as applicable)
If yes, please fill in mother’s name in the appropriate space provided below.
Fathers’s Name (Mandatory except where mother is a single parent and PAN is applied by furnishing the name of mother only)
S H A I K H
B A B U M I Y A N

Mothers’s Name (optional except where mother is a single parent and PAN is applied by furnishing the name of mother only)

(In case no option is provided then PAN card will be issued with father’s name except where mother is a single parent and you wish to apply for
PAN by furnishing name of the mother only) ✘

C / O : S I R A J W A G H O O F L A T N O
2 0 1 C W I N G W A F A C O M P L E X C
H S L T D S H A R I F A R O A D

A M R U T N A G A R T H A N E T H A N E

M A H A R A S H T R A 4 0 0 6 1 2 I N D I A
 ✘

9 1 8 8 7 9 1 3 9 9 0 3
konainkhamre@gmail.com

6 2 9 1 5 2 5 5 9 4 9 2

N I K H A T P A R V E E N S I R A J W A G H
O O

AADHAAR Card issued by UIDAI (In AADHAAR Card issued by UIDAI (In Copy)
Copy)
AADHAAR Card issued by UIDAI (In Copy)

NIKHAT PARVEEN S WAGHOO HIMSELF/HERSELF

MUMBRA
eKYC-Application

2 1 1 0 2 0 2 1
 Enrolment No.: XXXX/XXXXX/XXXXX
To
Download Date:21/10/2021

Nikhat Parveen Siraj Waghoo

C/O: Siraj Waghoo
flat no 201 C-wing wafa complex C.H.S ltd
sharifa road
amrut nagar
Thane
Thane Maharashtra-400612
Issue Date:10/10/2011

Signature Not Verified

Digitally signed by DS
UNIQUE IDENTIFICATION
AUTHORITY OF INDIA 04
Date: 2021.10.21 16:12:13
IST

6291 5255 9492

Nikhat Parveen Siraj Waghoo Address:

Download Date:21/10/2021

C/O: Siraj Waghoo, flat no 201 C-wing

Date of Birth/DOB: 11/05/1970
Issue Date:10/10/2011

wafa complex C.H.S ltd, sharifa road,

Female/ FEMALE amrut nagar, Thane, Thane,
Maharashtra, 400612

6291 5255 9492 6291 5255 9492

Signature Not
Verified
Signed by :NIKHAT PARVEEN S
WAGHOO
Date : 21/10/2021 16:19:36
Reason : eSign Service
Location : India