Acknowledgment for Request for New PAN Card or/and Changes or Corre...

Acknowledgment for Request for New PAN Card or/and Changes or Correction in PAN Data
Category Permanent Account Number (PAN) Name Name to be printed on card Father's Name Date of Birth Address for Communication Individual ANAPG8086B Smt. GUNJAN GUNJAN Shri SUBHASH CHANDER 31 - 10 - 1980 134 NEW MATA GUJRI ENCLAVE MUNDI KHARAR, DISTT. MOHALI KHARAR - 140301 Punjab 91 - 9915703134 DRGUNJANCSR@GMAIL.COM Signature Mismatch PAN3: PAN4: Sex

Affix recent photograph (3.5cm x 2.5cm)

Other Address Telephone No. Email ID Photo Mismatch PAN1: PAN2:

Request for cancellation of PAN(s)

Payment Mode
Net Banking: Your Payment of 94.00 against transaction number 401-172483 has been successfully processed. I/We, the applicant, do hereby declare that what is stated above is true to the best of my/our information and belief. The following documents are enclosed as: Proof of Identity: Copy of driving license Proof of Address: Copy of credit card statement Proof of PAN: Copy of PAN card Proof of PAN to be cancelled: Any other document: Signature/Left Thumb Impression of Applicant (inside the box without touching the sides & in BLACK INK ONLY) Date: 01 - 11 - 2011

Service Tax Code (Registration Number): AAACN2082NST001 Service Tax Registration Category: BUSINESS AUXILIARY SERVICES

1. The above-mentioned 15-digit acknowledgment number is a unique reference number for your application for 'Request for New PAN Card or/and Changes or Correction in PAN Data'. Kindly quote this number for tracking the status of your application on or any queries relating thereto. 2. Sav e and print this acknowle dgme nt. 3. Application fe e and mode of payme nt: Payment favouring 'NSDL-PAN' can be made as follows: Sr. No. 1 Addre ss for Communication Indian Amount payable ( ) 94 M ode of payme nt Credit card / Debit card / Net Banking / Demand Draft (DD) payable at Mumbai/Cheque to be deposited in any HDFC bank branch across the country (except Dahej). DD payable at Mumbai




Ple ase me ntion name of applicant and acknowle dgme nt numbe r on the re v e rse of che que /DD. 4. Individual Applicants affix your recent colour photograph, sign the acknowledgment (inside the box provided without touching the sides and in BLACK INK only) and enclose a Demand Draft (DD)/Cheque, if any, alongwith Proof of Identity and Proof of Address as specified in the application form. 5. Superscribe the envelope with 'APPLICATION FOR Change request PAN - Acknowledgment Number' (e.g., 'APPLICATION FOR Change request PAN 881010200000973'). 6. Send the documents as specified in point no. 4 above to Income Tax PAN Se rv ice s Unit, National Se curitie s De pository Limite d, 3 Chambe rs,Ne ar Bane r Te le phone Exchange , Bane r Pune -411045 Tel: 020-2721 8080; Fax: 020-2721 8081. 7. Your acknowledgment, DD if any, and proofs, should reach NSDL within 15 days from the date of online application. 8. Application will be processed only on receipt of relevant proofs and realisation of payment. 9. Applications without proof of PAN will be proce sse d on a good e ffort basis - (as me ntione d in guide line s).

floor, Sapphire

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11/1/2011 6:56 PM

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