~ Copy to be Kept with application ‘Tax Invoice cum Acknowledgement recelpt of PAN Application (Form 49A)_ eo ame [PSST it I a ne cou Jostm ac apptcat [NA honeartenane [con ae arom Fates Nana owsou ‘Mother's Name Saas: Orta of Bry nero 0 [communicator Adaess sui [UITARPRADESH | reuphon/ ate Number [S860 ean pAocounsrensmgsunt cu pret otimsny san crime Ung aan too Proototaddnes | MONA Candee tn iy ot a Proof ot 08 [OAR Gin rate nt PAN application fee Kala ser _ cast o% |SUVIOHA KENERA SHOP NO-5 GROUND F MAND! ROAD, NEAR PRATHAMA BAN [DHAWARS! AAGANPUR UTTAR PRADESH 264242 test 18% TotafRoundes OM) leerinzramacnaoenui2e ‘CIN: U72900MHI99SPLCOaSE42 | SAC 996319 This sw computer averatd receipt and does not requre signatreForm No. 498 ‘Appleation for Allotment of Permanent Account Number ave of indian Citzenslindian Companies/Entites incorporated in 'nciat ‘Unincorporated entities formed in Inca) ‘eeu 114 ont campenprg eens marge non ig pee ‘AOtyee | Range code. RON. P| Wi PAE a{s (Ws hereby request that a permanent account umber be acted 1 me We one below racessary parbculars ieee tetra apandes name we tionndw appearing ret enylte ot bition ecient mam are net permite Pama secite [7 ]asentanio [7s ou [linac [Jes [ Lastlame Suna Te Festtiome ago Hane T ATEN oAR TI Tate sy fost rib adhe Peel I TTT 3 Have youcver been inown by anyothername? — [Yeu [¥) Ho tyes ewe gue cect rone oes eeuct tin 7jerennicane [jam [Jom [Jeunes [its pereeeseeseecer| Last tame /Sunore, First ame cee Name el dt AS a ak ETERS | EL |_| RE oe NC ROE baie o Brwincorporation/AgrvementParnership or Trust Deed Formation of Body of individuals or Asaciation of Persons eee i On i] TARA 16 Detaia ef Parents (eppicabie ony for individual appicans) Aires nether ia sgle pert ol yo want aol oc PAN by tarsi th name o your mesh Oy? [yes W]e ipiease roxas apiiatio) iTyes plese 68 n motte’ rama in te appropiate space provide boon 1 se tory dept whe mother ea single parent end PAN a appa by fisting the name of mother on {inate / Sumi (CHAN OUT | i oi i | | L Fst ame i tii tre CI Toe ee Mother's Nome optional except whare mather is aS PAN apple frishing the rare of ether ont) isis oe cee me Beet eee aL Fiattiame it I ry I lia ‘mado Homo nan TIT tt tii tii all) cae haama tether ‘thor or har which your Robe pd on PANT ard (Sete ne ony FZirmersrone [[Werseome (Poe ta ae ‘reraoa noon src ten PA a lw wsu0d WA farsa ence nro mother srl parent ae you whip oP PAY by famshing name oe mater erty 7 adores Residence Address Flat Room 1 Doar Bock 0. Homa of Promases ( Bulting /Vlen? Fo /Sret/ LanerPost otto ‘Area Local Takes Sb: Oven oan Cty DentOffice Address 7 at ofce Fi! Room Dae Block No. Heme of Premises / Baking Wage Read Steet /LaraiPos! Of ‘Are /Lwaity/ Teka! Sub- Oras Tow Cay Disc ‘State / rin Teron [ 18 Aadress for Commnicaton 9. Telephone Number & Ema 10 deta Caurycote eySTD Code (+, 9] I ena [sachineomputers22@qmail.com 40 status of applicant Hace soid ua (es otaile [leamerens Fwd [_]Hnaseiwonatanny [__|Camany [eaimorsno Frm [F Asenconen o Poon Fine (Clestraemias —_ [Jtaininaty Tea jtuatPecone [] Uri Luby Puttin 11 Regisrion Number for company, thre, LLPS st) L WTTTT IIT tittitii tii titi a ious obaputonvn mined ce aaa mre oe Evemen@oiAsea eppeaton term ae pr secon 39M oe mamnnnme vans) (310166 FZETS | rae ean nonnar nol atotnd, nse ecton the rite Ant apes GULL eet eee ee ELIE None wx pr AACHUAR ioe cr go es Evo Do Pier wai fy ——_—— es RAEN DAR Et Tae f ] i} [ | | T Cir ia COLT 4. Source efincome Please select [| #8 aopicable (J satay [] copeat Garss [| iar fon snes Petsson SuaressProsson cose TI rercote net memetors) [7] comet on sores Ingman Ho. rope [| teincome “414 Representative Assesses (RA) Rare ec ofthe presenter Aceon wo esate une Tu tc THA PE Ii Pen. woes particulars have been given inthe column 1-13. Full Name (Full expanded name : nitats are not permitted) pmvesoatn /|oemmacom (ss [Js [ Last are / Sumame T First Hares ml Wie ame i ares Flak / Room Dor lock No. CLL I TC LLL ame of remiss uksing / iage Road / SroetLenaiPost Oreo | [ T i ‘en /Locity Taha Sub- Dosen Town iy Best Ste on Trtny Priced [ l 15 Docuinents submited as Proot of Weertity (POH), (Weave erdosed [AADHAAR CARD ii scitadiessind ta ADUARR CARD) Sapte AY [Poti reer to the insractons (as speced in ule 114 oT wes, 7362 fr Isto mandatory cried scuments tabesubmited as applcatie Vrmere A. ease & AnexuieC of 0 be wed eroverapeate) LI 1 cf ot Aderasa @OA) and Proof of Date of Birth (POB) ] es moc osentty, (AADHAAR CARD 1 We (@ATENDAR ——_], the applicant, the eapacty of rmsecr——— rl a ~10S HIVL. | | VS “aare La Tomb ipsa of Date ‘aia aie the)art WORT - Goveitimientof tndia’ ad ayendor 3% fa 98 :ouoUTs Uy ae 3910 1667 2218 Say - HT Heat ar arferenre