'f Permanent Account Number tas incorporated in inci! {titles formed in inca) Jeo ue tte ange code “AO Ne. Tale ell ‘omelus — -n proof of identityladdress documents: initats are not permitted) “Jromat_[_]Me TOC miata mil Jremaie [_] Tenegender (please tek a8 sppleable) = er ree sramt ersten Pee - = senstng he nae your moter ony? Ye] No[ tet sete ye pass 7H TOBaTa rae Te aeons pee pon bm ies TS can at mcs easing prot and PAN appa by fishing te name of mathe on) Last Name / Surname [RQ | ce Fest Nome yA Tapate lal Taira sagantioaes. + [ralmabe oa [aie retnare Nome (optional ezopt where mother sa single parant and PAN ts aiid by furs ron) Last Name /Sumame as alotaled ie. FirstName zi a a Mile Name het Panel ete fat a Sete nae ene fair ar rather wih ou Tay eto be ped SPAN care (eae or Fone || Motor nae ean 8k 26 aie) (epen no opton pre tn PAN cad vl be eth oer nama exert whre mater pare a you wah 0 PY Saxby tumching nate afte ster coy) patrees Residence Address, Flat/ Room / Door Block No. Name of Premises / Bulking / Vilage Road / Steet LanelPost Office ‘ea Local Taluka! Sub- Division Seer ies