Professional Documents
Culture Documents
Request For New PAN Or/And Changes or Correction in PAN Data
Request For New PAN Or/And Changes or Correction in PAN Data
Only Only
'Individuals' 'Individuals'
to affix recent to affix recent
photograph photograph
(3.5 cm * Permanent Account Number (PAN) (3.5 cm *
2.5 cm) 2.5 cm)
A V X P N 1 5 1 5 B
Please read Instructions 'h'&'i'for selecting boxes on left margin of this form.
þ1documents:
Full Name (Full expanded name to be mentioned as appearing in proof of identity/address
initials are not permitted)
¨
Please Select title,
þ ¨ ¨
as applicable
¨
Shri Smt Kumari M/s Signature/Left Thumb Impression
Last Name/Surname K U M A R V E L U S A M Y
First Name N E E L A K A N D A N
Middle Name
Name you would like it printed on the PAN card
N E E L A K A N D A N K U M A R V E L U S A M Y
¨ 4 Gender(for 'Individual' applicant only) þ Male ¨ Female ¨ Transgender (Please tick as applicable)
þ 5 Photo Mismatch
þ 6 Signature Mismatch
¨ 7 Address for Communication þ Residence ¨ Office (Please tick as applicable)
Email ID neelau2@yahoo.com
¨ 10Name
AADHAAR number (if alloted)
as per AADHAAR letter/card
4 2 0 8 7 5 2 1 4 0 1 2
N E E L A K A N D A N K U M A R V E L U S A M Y
¨11 Mention the Permanent Account Numbers (PANs) inadvertently alloted to you
PAN1 PAN2 PAN3 PAN4
12 Verification
NEELAKANDAN KUMARVELUSAMY HIMSELF/HERSELF
I/We ,the applicant, in the capacity of do hereby
declare that what is stated above is true to the best of my/our information and belief.
I/We have enclosed 1 (number of documents) in support of proposed changes/corrections.
Place VELANKANNI
D D M M Y Y Y Y
Date 3 1 0 1 2 0 2 3
Signature/Left Thumb Impression of
Applicant(inside the box)