Application Number: A058285296

Application Number Bar Code 2228171823341964 / PY0078315708

Payment Reference: Inward Number Bar Code
Payment Date: 16/08/2022 Rs.107.00/-
Application Source: EWALLET - A - CSC E GOVERNANCE SERVICES INDIA LIMITED Application Date: 16/08/2022
User Id: 245564530010 User Name:

PAN CARD MODE : Both physical PAN and e-PAN Card Application Mode : Physical Application

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A S S O C I A T I O N

A S S O C I A T I O N

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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)

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)

Y O U N G W O M E N C H R I S T I A N A S S
F A T I M A N A G A R
I D E A L L A N E P U R U L I A R O A D
D A N G R A T O L I
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sheelademta08@gmail.com

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K H E S S
M R I D U L A

B A S A R T O L I
C H U R C H R O A D
B A H U B A Z A R
R A N C H I
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Registration certificate issued Registration certificate issued by

by Registrar of Firm or Registrar of Firm or Partnership
Registration certificate issued by
Partnership Deed (In Copy) Deed (In Copy)
Registrar of Firm or Partnership
Deed (In Copy)

MRIDULA KHESS PARTNER

RANCHI

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