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PAN Application Acknowledgment Receipt

For Form 49A
( Physical ApPlication )

Received Rs. '107.00/ (incl of SMT BEGAM MURSHIDA

taxes) from
Application No./CouPon No' u-A050710'184
Name to be Printed on PAN card BEGAM MURSHIDA ilxrffifltfrflilffiffil$
Gender FEMALE A060110184
Date of Birth/lncorPoration 01/01r1955
Fatheis Name LALCHAND MOLLICK
Aadhaar Number/ElD Number xxxx-xxxx-6750 (MENTIoNED' IllarcHE0)'
Name as Per Aadhaar BEGAM MURSHIDA
Applicant's Contact details 7699094499 / sorifuln0029@gmail'com
Communication Address RESIDENCE
Residence State WEST BENGAL
Proof of ldentity AADHAAR card issued by UIDAI (ln copy)
Proof of Address AADHAAR card issued by UIDAI (ln copy)
Proof of DOB AADHAAR Card issued by UIDAI (ln Copy)
Receipt
Date of 0611012022 11''17 t27
Pancard
I\,4ode of Both physical PAN and e-PAN Card
Payment Re{ No 68575'1541 / PY0081745991
Payment Date 06,1012022 11 '1A '42
DEIIIOGRAPHIC OETALS 'WILL BE LINKEDWTH PA'N'
'*O'O*
'O'"*'O '"'NO
PAN Service Center Code SUBRATA DAS
1 9054531 53474640
(SignlStamP)
PAN Service Center Name
Received for submission to UTIITSL
SUBRATA DAS
Centre Contact Details:
APSTUDIO.KOLIA@GMAlL.coM
19007303270

06-r0-2012- l1
 110184
{{l ilfllllllfliltil 685751541 / PYo I 745991
0611012A22 Rs.1 a0t
LET K- AIL LIMITED 1 o22
19 153474640 19
PAN CARD I,ODE : Both ical PAN and e PAN Card cation l\,4ode : P Appli
Form No, 49A
Application tor Altotment of permanenr rqccon,lt Number
Ilh lhe case of In.lian Ciiizensl lndian Compsnies/ Enrities tncorporated in tndiai
Unincorporat€d entities fohed in hdtal
Se. Ruto 1.r4

B G 1 4 6 I 1

sir, lrwe hercby request that a permanonl Acouni Number be auolled io metdr,
,We give below neEssary padiculars: &"a,- s{N\r
1 Full Nams (Fullexpatrded nams to be fieniloned as .ess documents: nritiats are not pe
Sni
IV U R S H D l
B EG M

l I I
2
AE G M M U R s H i D
I

3 Have you ever been tnowo by any other nam€? )l (Flease tick as appllcablc)
lr yes. ple.se sive rhat olher name

a Snn

I
Fi6l Name

Gender for lndlvldlal appttc.nts on!y) Transge.der tplcas. rick as appt calrte)
5 D:t. of Bidhilncor.oraroh/Agi.em.nt/panne.sh,O o. irusl D".cdl D.y Monrh

6
rormatior of Aody ot niividuats.r associatio..f persons
Deiails of Parerls {applicibre o ty lor ii.riv dual ap.li.:nls).
Lqf Etr Fl,lsFl
Whelrermolher is a s ngle parenland yo! vnsh 10 app y lor FAN by lurish fl] the tume of you. mother only? Ys
lfyes, pleaselillln motheas name lnlhe appropnalespa.e pr.liie.j beow.
)l (please tck as applcable)

Falhers's Name (ltandatory except wne.e molher is a parenrand PAN is app ied
N,] o L L c K
L L C H ND
MotheB's Name (optional

:r' .lFr: ..'!i:rf r:.in ir.)i ri vr'nlch you may like lo be prinled or PAN card / a^, a,&r
(ln no oprion s provided then PAN.ard wr ^./.( morheris a singre parentand
be issued wrlh farhers name exceplwhere
'ase
PAN by tumishin! name of ihe holher

R6sidenceAddress
x tr :if.:l] .. ,,r., i:.rrl

. Flal / Room / Door I Btock No.

C o LU T R I\,4 o L L
Nafte of Premisos / soitdino / Virraqs K o L
Road / Street / lane/Post Omce N B G R M S K I U R
Aea / Localiry / Tahr€/ sub, Dtvision S H IV U R
.Towr / City / District H o R H
Slate / Uniofl Tefliiory
WE S T BENGA L 7 1 1 IND IA

FLar / Room / Door / Btoci( No. I

I
Name or Premises / Buitdi.g / Viltage
 ' ,, / Taluka/ Sub- Division

Address ior Comnlu nication

I" Telephone Number & Ema lD detaits
x lPreasc Uck as appii.ablc)
Co!,rlry code Area/STtr Ccce -Ie
ephone / firlobile number
a ) 9 LT 4 t
sorifuln0029 com
10 Siihrs ol appricanr
Please setect srarus.
Ias arfricaOre

x Hind! undlvided lamlty

Associaiioa ot Persons

Lln]ited Liability Pannership

11 Regisrr.tion Nuhber (ior.ompany.Iirnrs. LLps erc_

a person who is required to qlote Aadhaa. numb

otAadhaar apolicatioD lonn as per seclion 13SAA
Please mention your AADHA,AR .umber (ii altolied) l a 3
'i
ll
number is noia,toted, ptease m€niion the enrcinini lD ofAadhea,

II -.
Name as pe.AADHAAR terler/card I lr -i: i-ir_in.
B G l\l i\,4 U R S H l D

13 Sour.c oftncome

tr.,"' LJ ,rcom. ,rom -.Lse p.o.edy f lr.,"i"-."

lfi@mB from Busine$ / prcfession Bls'nesyftofession code
lFor Coder Refer insrlciionsl lncorne Jronr oihersolrcEs x
14 Reprcsenlative Assess€e (RA)
Full hame' address or lhe BePreseniative As$Essee.
who is assessibre under the rncdme Tar Act in rcspecr oi the peison,
been siv€n in the cotumn !13.
whose parriduiars have
Full ame (Fu,l expanded nBme : iniriats are nor
Formitted)
Sh Snrt

i.l ir i ! 1 ll
tI

Flat I Boom / Door/Abck No. c o L

Name ot Pr€mises ,t &iitding / lrltage
Rdad / Street / LaneJPosr ofice i. C S I Ii i
Area / Locality / laluka/ SuO. Division il I t1
-n
T@n f City / Oislrici H o 1t !i
WEST BENGAL 1 : 1
15 Docn.r.nts subrnirted as p..of of tde.tily (pot), prooi and Prooaof Oare of Bidh {OOB)

ss
as proof of address and a tssu I
as prooi ol date ot bift
lPle.se reler io the inslrucriois (as specltiod in Rule 114 oi 1.1. RuJes, 1862) for tist !f mandaU]ry.enifred dorumsnt5 io be slrbmined ae appticabtel
'[Annerrure A, Annexu€ B & Anrexure c are b b6 lsed

lhe applicanl jn lhe capacny of

do h€reoy d€cae lndL whrl,s slared 6bovs rs tde lo rhe bplr oi mrour rr,omal on a1o oelet
KOLIA

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signalle 1Left Ihumb |rnpressio ot Appracant (inside the box)
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Enrolmern No.: 0820/37540/00S36

E Nowh W€sl B*€aJ 711315

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3lTcFFr.iil:. -,rr€F/ \/our; i i,r I ,. No.

3655 3815 6750
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