Application N

Payment Reftrence 30225506657

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Payment Date: 161 1Ol2O22 Rs. 1 07.00/-

Source: ALLET-A-CSCE CES INDIA LIIVIITED Date:

User ld 251 375370019 User Name:

PAN CARD MODE : Both physical PAN and e-PAN Card Application Mode : Physical Application
Form No.49A
Application for Allotment of Permanent Account Number
[in the case of lndian Citizens,' lndian Cornpanies/ Entities incorporated in lndia/
!,h r"lnlnerpryd €rltities ferasd in ln*ial ," h*
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Td ayeid i"&t*kee, pleeqe &nr&..Cra€@rrFlnying tnstrtdions 6i{id,*}€rndes b€6oG fiffmg ilp ho ftdnr

Assessing olficer {AO code)

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Area code AO type Range code AO No.

L K N W I 0 9 2

$ir, flAre hereby requs$t thata reffiansnt Aoesuat u,raber bq atlotted to rye/qt,
gire
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l^/Ve beFovl necessary parliculars:

{ Full fiam* {Fult expanded aanrre t*r be mentioned as in proof of initials are not
Please seiect tltte, I
../ I as applicahle x $hri i\4i s

Lmti{anrel Surname M ,AlN I S H

j
Fil}truame I

lHi*dte htaa*a 1 l

2
M A N I S H I I

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3 Have you ever been known by any other name? l-l v** (plea$e tick as applicablei
lfye$" pl*ase giue thot oih*rfiarfi,B
Pleese s-elect title, Shri L4is

Last Flsrna lSurnerne

Firsl Nar:re
Middl€ t{arne

4 Gender (for lndividual applicants on!y.} x Male

f r**",* f] rransgenUer {please ti$k as applicable}

5 Oate of Birth/lncorporation/Agre€ment/Partnership or Trust Deedl

Formation of Bocly of individuals or a$sociatiofl of Fersons 2 5 0 7 2 0 0 4
6 Details of Farents {applicabfe only tor individual applicaftts},
Whether mother is a single parent and you wish to apply for PAN by fumishing the name of your mother only? Yes No x (please tick as
If yes, please fill in mother's name in lhe appropriate space provided below.
Fathers's Name (Mandatory except mother is a and PAN is the name of mother
Last lianle I Surnanre P A S W A N
First lriame K A P I L
fuliddle Nanre
Mothers's Name {optional except where mother is a and rs the name of mother
Lest *{alr}ef gtrmsxne,

Fiffit Ftrarrrs,

Middle Hame
,$*lert lhe name of eitherfalher whifh,yeu may be sfi ,sii*ffr {tr+ sr+i}
(ln 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) x FEthsr's name fu'ltlther's Name flra* ( ritL ot qryiitthl,.!
7 AddyeEs
Residence Addrese
Flat / Room I Door 1 Bbck No,
W A R D N o 3 2
Narne of Premise5 / Building / \liltage
B H o o R A R A N I

Road i Srreet i Lane/Pust Otflrce I\4 A T K o T A R o A D

Area / Locatity / Taluk# SuF Division B H o o R A R A N I

lftvri J +tty / Sjstrist . U D H A M S I N G H N A G A R

$tale I LJni*n Trrrit*ry Pinrcde j Zip code Cr:*ntry Nam*
UTTARAKHAND l2l0 3 1 5 3 INDIA
0ffrce.Addrsss
Nameotofies.
Fl6t I fi!6m I Dourf Bgock Ns.
Name of Fremises / Buitding i Village
Road / Stri*e{ / Lan+ltrost Sffhe
 Area / localily X Talu*{af $utr Fivision
Ta+nl*ltvlFisEiat

S Address fi:r Communication x Residence Officr (Please tick as applrcable)

I Tetephone Numtrer & frnail lO dctails
eountry AreafSTB eode
9 1 B 0 0 6 6 'l 6 4 B 4

Ernaif 15 guptaankitku maro 1 @gmai l.com

10 Statu6 of applicant
-7-
lr/ las aonlicable
Please select status..L_-J
Ie**,,'*un'
l-lHincuunclvi**aram*ir flro*p*rn flr****tiB:Firnr f]e**e*+attonof,P$Bryq
of lndividuais
Iriusrs ilt*, I r-*"r, Authority LjryO1ci* JuridicatPersone
fl*nnea Liab'ilityFa*nerettip
11 Registration Numhrer {for cor*pany, firms, LLPs

1? lrr Case of a persoo. who is required to guote form a+p*r section 1394A
Please mention your AADHA,AR nurnber (if allotted) 2 3 B B 9 6 L
IfAA*tiAAH number is n*t ,f0rfB
it
I tt I I
l$ame as peTAA0HAAR *fAadhaar f+rrrr

M A N I S H I
J

Source of lncome Please seiect, lZ "*

applicalrte
salary f] ,,,** fiom House property f{o inccrne [ *pur,u*i*-
Income from Business / Profussion EusrneqsrFrqfessian Gode [F'or : Sode: Hef-er i*sh, u*lin:re] f] r*"o*t om sther $ail*ffis
who js assessible undar the lncome Tax Act in respct of the person, whose particulars have
b*en given in lhe esiurnn 1-J3.
Full Name (Full expanded name ; initials are nol permitted)
r--:1
iy' | as applicable
Pleese select title,,L:J

Last$iame /$l'tl'name I I

Firsi,lilarne i I

Middle,trlame l

Addr*:s*
Flat l,E*-+rn I foat t mlosk l'*s.
Nerne of Prerr$ses / Building I Viliage
ftead.l gtfeet/ LaneiP*st $fftee
Area / Locality / Taluka/ Sub- Division
lown I Urry/Urstnct
S,bts, J l",ni*n lbrit*ry Pincode
'15 Docurnents submitted as Proof ct tdentity (POt), Proof of Address {POA} and Proof of Oate

liWe have enclssed as pr*ef of idenr,ry IAADFIAA[Card issued by UIDAI i

as proof+f address 6nd as proof of date 0f bjrth.

[Annexure A. Atnexr.rre B & Ar:nex,.rre C are lo be ilserJ wherever ar:plicabie]

t6: ifl,A/s lh* :rpplicant. ifl the capacity of

do hereby deerare thal wtat is slated above is true to the best of my/our iflformation and belief.

Flace; RU
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,* P,M, M Y Y Y
0ate l 1 6 1 0 210 2
Signature,rLeft Thumb lrnpressiori oi. p'pplicant (in*ide th* box)
10116122,1:49 PM about:blank

PAN Application Acknowledgment Receipt For Form 49A

( Physical Application )

-ffiffiffi::' *Jp.T
Gender MALE lllillffilllllililffiilllillil
Agii i i644g$
Date of Birth/lncorporation 2510712004
Father's Name KAPIL PASWAN
Aadhaar Number/ElD Number xxxx-xxxx-4774 tmexrroNEo, MATcHEDT

Name as per Aadhaar MANISH

Applicant's Contact details 8006676484 / guptaankitkumar0l@gmail.com
Communication Address RESIDENCE
Residence State UTTARAKHAND
Proof of ldentity AADHAAR Card issued by UIDAI (ln Copy)
Proof of Address AADHAAR Gard issued by UIDAI (ln Copy)
Proof of DOB AADHAAR Gard issued by UIDAI (ln Copy)
Date of Receipt 1611012022 01:00:50
Mode of Pancard Both physical PAN and e-PAN Card
Payment Ref No 228913A225506657 / PY0082390868
Payment Date 1611012022 01:02:.18
*AADHAAR MATCHED USING DEMOGRAPHIC DETA]LS . YVILL BE LINKED WTH PAN.

PAN Service Center Code

ANKIT KUMAR GUPTA
251375370019
PAN Service Center Name ANKIT (Sign/Stamp)
KUMAR GUPTA Received for submission to UTIITSL
Centre Contact Details:
GU PTAAN K|TKU MAR01 @GMAI L.COM
/8006676484
To know your PAN.Application status, you may visit our website: httpsll$0uru!!!!S!@.
As per instruction from lncome Tax Department, an authorized agency's 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 authorizalion letter/lD card from the
agent before verification.Your cooperation is solicited in this regard.

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