Paga

Annexure-$2

Request Eor Change/Correction in_Subscriber Master details And/OrReissue of I-Pin/T-Pin/PRAN

For POP-SP
POP-SP Reglstratlon No.
Date of Receipt

Receipt No.: I

Entered By : 110182049895 Date: 04/07/2922

Verifed By: Dato

PRANis nandatory. EIl only the field(s)_which islare to be nodified with the revised details.
Ihereby request for the following detalls for the change. (Please tlick )
) Change or Correction in name
I ) Changes or Corection In other Personal
) Changes or Correctlon In Nominatlon v ) Relssue of I PIN and/or TPIN
V) Relssue of PRAN Card

Pemanent Retirement Account Number 110182049895

Section A - Change 1n Personal Details

1 . F u l Name (Full expanded name: Initials are not permitted)

Please Tick as applicable
First Name
Sh Smt Kumar!

Middle Name

Last Name

If the correction in the name to be made in Hindi,

2 . Gender Male Female

3 . Date of Birth

4. PAN
GovemimentPrivate S e l f Employed NRI Ohers
| 5 .Calegory:
6 . Fathers Ful Name:
First Name

Middle Name

Last Namne

7 . Present Address
FlatUnit No, Bbck no.

Name of Premise/Building/Village

Road/Street/Lane

LandmarK

District/Town/City
State/ Union Territory

COunuy

Pin

8 . Permanent Address: f same as above, Please Tick es

Flat/Unit No, Blbck no.

Name of Premise/BuikdingVillage

Road/Street/Lane

Landmark

District/rown/city

State/Union Teitory

Country Dgialy
ARAM S SARAM SAKIURWADE
SAKILURWADE
a :49 IST 2022
Pin Code