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    Acknowledgement Number N- 882036148444610 SV ANNLAUUO0U AU AEN 2A, Form NO. ‘Application for Allotment of Permanent Account Number [in the case of incian Citizens/indian Companies/Entities incorporated in Indial Unincorporated entities formed in ina] ‘Under section £398 ofthe Income Tax act, 1964 /ndviduals to aterecent ‘To avoid mistake), please follow the accompanying instructions and examples before filing uy ont ome (ohh anying ‘aur Assessing officer (AO code) ‘Squat Thane messer_| [AREA CODE ‘AO TYPE Range Code | AONO [ous w 701 2 Sir, le hereby request that a permanent account number be allotted to melus. We give below necessary particulars: + Ful Name (Fl expanded name tobe mendoned ag appearing in proof of detiadcess documents nae ae not permite) Saale TEE TRIE TapressONG Please select title, as applicable Shri ‘Smt Kumari] ws Last Name/Sumame “ARIHANT san 0. OP. HOUSING SERVICE SOCIETY LIMITED First Name Micate Name 2. Abbreviations ofthe above name, as you would like it to be printed on the PAN card [ARIBANTKUTIR CO. OP- HOUSING SERVICE SOCIETY LIMTED. ] ‘3. Have you ever been known by other name? that other name O ves No sse select title, as applicable DO smi OF sm. OF kum Os Last Neme/Sumame Firet Name Micale Name 4. Gendertfor individual epplicants only) ‘Wale Female Transgender ‘5. Date of Birthincorporation/AgreementPartnership or Trust Deed! Formation of Body of individuals or association of Persons Day Month Year fisosa011 6 Details of Parents (applicable only for individual applicants) Whether mother isa single parent and you wish to apply for PAN by furnishing the name of your mother only? Yes No (please tick as applicable) Iyes,please fl in mother’s name in the appropriate space provided below. Father's Name (Mandatory except where mother is a single parent and PAN is applied by furnishing the name of mother only) Last Neme/Surname Fist Name Miaaia Nama ‘Mother's Name (Optional except where mother Isa single parent and PAN is applied by furnishing the name of mother only) Last Neme/Sumame First Name Mice Name Soloct the name of ether father or mothor which you may lke fo be printed an PAN eard (Select one only) {in case no option 's provided then PAN card wil be issued wit fathers name) Fethe’s Name Mother's Name (Please tick as appiesble) (in case no option is provided then PAN card will be issued with father's name except where mother is single parent and you wish to apply for PAN by furnishing name of mother only) ‘Address Residence Address Flat / Room / Door / Black No NEAR GARDEN RESIDENCY 1 lame of Premises / Building / Vilage [GALA GYMIKHANA ROAD Road Stet / Lane/Past Omics NEAR KAMAL NAYAN BUNGLOWS ‘Avaa / Localy/ Taluka’ Sub. ‘SOUTH BOPAL ‘Town / Cty Das ‘AHMEDABAD State | Union Teritory Pincode / Zip code ‘County Nene ‘GUJARAT ‘360088 INDIA ‘Office Address Name of office ‘ARIHANT KUTIR CO. OP. HOUSING SERVICE SOCIETY LIMITED Flat/ Room / Door / Black No TEAR GARDEN RESIDENCY 7 [Name of Premises /Bulaing Vilage [ GALA GYMKHANA ROAD Road! Soot /Lane/Post Office NEAR KAMAL NAYAN SUNGLOWS ‘rea / Locality / Taluka! Sus- Division "SOUTH BOPAL ‘Town / Cy Das ‘ARMEDABAD Stato Union Teeny Pinca / Zipcode Country Name GUJARAT 360088, INDIA Address for Communication Tl Residence OD once Please tick es applicable 8. Telephone Number & Emil ID details county code ‘Avea/STD Code Telephone / Mobile number a a72eR68aT6 mati 'SWAPNILS01@YAHOO.COIN 10. Status of applicant. Please select status, as applicable OF Govemment 7 rdividuat Di Hindu undivided family EJ Company 1 Partnership Firm [Fl Association of Persons O tmsts D Buy of individuals D Local Authority [OJ arincial Junaical Persons [Limited Liabilty Partnership 411,_ Registration Number (for company, fms, LLPs ete) 2516 12, Incase of a person, who Is required to quote Aadhaar number! the Enrolment ID of Aadhaar application form as per section 138AA Please mention your AADHAAR number (if allotted) I AADHAAR numbers not allotted, pleaso mention the enroiment ID of Aadhaar application [Namo as per AADHAAR lattericard or as per the Enrolment ID of Aadhaar application 43. Soures of income: Tae, usnasPoesson (rorcaie Retervsneten) EP Cm Gans 1 income from Business / income trom omer sources 1 ncome trom House proverty DD Neincome 414. Representative Assessee (RA) Fullname, adcress of the Representative Assessee, who Is assessible under the Income Tax Actin respect ofthe person, whese particulars have been given in the column 1-13. Full Name (Full expanded name : ntals are net permitted) Plase select ila as applicable Oo sm O st Okuma ms Last Nemeisurnama Fst Name Middle Name eos Flat Room / Door Black No [Name of Premises / Bulding / Road / Stroet/ Lana/Past Office ‘Area / Locally | Taluka’ Sub- Division Town / Cy / Distr ‘Stato / Union Tertitory Pineade Country Nemo 15. Documents submitted as Proot of identity (PON), Proof of Address (POA) and Proof of Date of Birth (008) lie have onciosed [Certificate of Registration Number issued by any other Competent Authority as proof of identity (Cerificate of Registration Number issued by any other Competent Authority as proof of address and os proof de oi, ns as spoioTn Ras 4 GT Res, TOE or Tf Mendon cai ocueTsTo Dees IPiease reer to re mst ‘applicable jAMexure A, Annexure 6 & Annexure C ara to be uses wherever applica} 10 Vive [JABUBENRABARI_] the applicant, nthe capacity ot __[ Authorized Signatory

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