JAMMU era {pplication Source: EWALLE, SROSee |Apalication Date:(27/1 2/2022 (515331460015 Jus. Jee &-PAN Card, Form No. 498 ical Application, Application for Allotment of Permanent Account Number 2AN CARD MODE : Both physical PAI of Indian Citizens/ Indian Companies Entities incorporated in incia) Unincorporated entities formed in India) Rody tne ‘ear maa pean ow he ezoang crs examen am ‘Assessing officer (AO code) ‘rea code ‘AOwype | Range cods | _ AON, L K Nn LW 6 1 9 5 Sir We ere request hata Permanent Account Number be alte to me/us Ine give below necessary parkears: oy 4) Full Name (Full expanded name to be mentioned as appearing In proof of idonitraddress document: Iiials are no! permited) Prease select tive, [y/] as applicable shi [x] sme. rract_ [Yous Last Name / Surname! Dew I 1 Fest Name MIALY A Mile Name 2 Abbreviations ofthe above name, as you would kei to be printed o 2 MIA|Y/A] [DJE|V fe) Sie get | 3 Hoveyou eer been known by any otmerneme?— _]vea [] Wo (Please tikes applabi) lees. ease gv that ter name Please selec te,[y/] a8 applicable [_]shvi sm, []ekumat [7] vs Last Name / Sumas Fist Name | Mie Name at 4 Gonder ot nv ppans nt) [Jae [ie] romate [Jrranagender peas toc as spptcabe 5 Date of Birth/ineerporation/AgreementPartnership or Trust Deed! Oey sacenn we Formation of Body of individuals or association of Persons ol) fol1] [iJelste) © Detaleof Parents (applicable ony for Incivdual applicants), ‘Rrores momar sal patent aa ou wis to py fr PAN by fanshing he ame ofyourmaher ony? Yel _] No[X] ease kas apa} ifyes, pease Bi n mohor's namin the appropriate spave provided below. Fathers’ Name (Mandatory except where mother fs a sng parent and PAN i applied by furnishing te name of mothe on Last Name / Surmame [PJAIN[DJEly) First Name RiAlM Mid Name LIA|G IAIN [ T Mothers's Name (optional except where mothe sa single pare and PAN is applied by furnishing the name of mother only). Last Name / Surname FistNave Lt ‘Migdle Name I rH ‘Select the name of ekther father or mother which yOu may tke fo Be printed on PAN Gard petnco) (rene ss opie aied Pt PAN ad wlbewsoadwah hers gaa step wer eatin ase pro [x] rotecarem [= [etic tave ower AN by furnishing name ofthe mother ony) 7 Address you wish to apply for Residence Address T Fit / Room ! Door Block No. 2 Nar of Premises / Bulking / Vilage Road / Sto LanalPost Office at fe oraty Ta Orin, (EAT aia ‘Town / Cty /Distit TI r ‘State Unin Tory Pincode |Z code [UTTAR PR ager A ! nese ] Ll Loo eet Flat / Room / Door Btck No. ame of Premises /Bulling / Vilageeso Pere H Sonics 8 Address for Communication x 9 Telephone Numbor & Email ID details Country code —_ArealSTO Code [ si 92 Sfole [2 [5 [3 [ofa [6 ]2 e l fei Ematio 10 Status of applicant Presse eect stati, [7 ]as appa Elites x Dns 11 Rooks pany, firms, LLPS hit: - (El eiciniiotion: Tlbiaie (Clecrtinriay [flo es ot ‘2 In Case of « person, who is required to quote Aadhaar number/The Enrolment ID of Aadhea’ application form as per section 139AA ‘ease mention your ADHAAR number (allotted) [3 [1 [0 Gletsts) Gislal7 'WAADHAAR number is ot aloe, please mention the enrolment ID of Aadhaar application form etait toe Tl ee Sic ial I 0 Nama 6" AADHAAR lta ors pe th Eira thas ppaton fr MIALIA_[ole I ose ste, [7] es ppicatte inset fhenrac 14 Representative Assossee (RA) Fullname, address ofthe Representative Assessee, who ls assessic ‘been given in the column 1-13, Full Name (Full expanded name : initials are not permitted) Income from Business / Profession Business/Protession code [7] enetrmrissions {nese ew canines fe under th income Tax Aet in respect ofthe person, whose particulars have Pm soca |[7Jenoopuate [Jom [Jane Ce J Last Name /Sumame Frat Name Mie Name [ Address Flat Room / Door / Black Ne. Name of Promises / uleing / Vilage Road/ Street LanePost Omics ‘Area ! Locally Talia Sub- Division Town / City / Distt State / Union Tantory I Pineote 16 Documents submitted as Proof of identity (POI), Proot of Address (POA) and Proof of Dale of Birth (DOB) le hove encase [AADHAAR Card 58067 BY) esprootoriteniy, RADHAAR Card ested by UIDAT] 28 proof of address and [AA Card issued by (Please refer tothe Isirvcton (as spedfed In Rule 114 of LT, Rules, 1962) fr Ist of mandatory cated documento be submited cs apc} IAnnenure A, Annexure 8 & Annexure C ara to be used wherever applicable) 16 we MAVADEV! + the appcant inne capacty ot HIMSELF/HERSELF <é hereby decir that whats stated above is true fo the best of myfour information and belie, 28 proof of date of bth, Place sASTI D Date z DM 7h y iz a PP ‘Signature / Lot Thumb impression of Appicani (inside the box)