Copy to be kept with application
Tax Invoice cum Acknowledgement receipt of PAN Application (Form 49A)
Tax Invoice cum
N - 079529700021284 Date- 19 Sep 2018
Acknowledgement Number
Category INDIVIDUAL GSTIN of Applicant NA
Applicant's Name RAJBIR SINGH
Name on Card RAJBIR SINGH
Father’s Name RANJA RAM
Date of Birth/ Incorporation 25 May 1982 Communication Address State HARYANA (6)
Telephone/ Mobile Number 91-9468090032 E-mail ID MONUCHUNKAR33@GMAIL.COM
Proof of Identity AADHAAR Card issued by the Unique Identification Authority of India
Proof of Address AADHAAR Card issued by the Unique Identification Authority of India
Proof of DOB AADHAAR Card issued by the Unique Identification Authority of India
On behalf of NSDL e-Governance Infrastructure Limited (PAN-Centre Managed by NSDL) PAN application fee `91.00
Branch ID: 07952 CGST 9% `0.00
Vertex Customer Solutions India Private Limited SGST 9% `0.00
DSP ROAD NEAR RAVIDAS CHOWK FATEHABAD FATEHABAD HARYANA 125050 IGST 18% `16.38
Total(Rounded Off) `107.00
GSTIN:27AAACN2082N1Z8 CIN: U72900MH1995PLC095642 SAC : 998319
This is a computer generated receipt and does not require signature. Online PAAM 1.2
Applicant's Copy
Tax Invoice cum Acknowledgement receipt of PAN Application (Form 49A)
Tax Invoice cum N - 079529700021284 Date- 19 Sep 2018
Acknowledgement Number
Category INDIVIDUAL GSTIN of Applicant NA
Applicant's Name RAJBIR SINGH
Name on Card RAJBIR SINGH
Father’s Name RANJA RAM
Date of Birth/ Incorporation 25 May 1982 Communication Address State HARYANA (6)
Telephone/ Mobile Number 91-9468090032 E-mail ID MONUCHUNKAR33@GMAIL.COM
Proof of Identity AADHAAR Card issued by the Unique Identification Authority of India
Proof of Address AADHAAR Card issued by the Unique Identification Authority of India
Proof of DOB AADHAAR Card issued by the Unique Identification Authority of India
On behalf of NSDL e-Governance Infrastructure Limited (PAN-Centre Managed by NSDL)
PAN application fee `91.00
Branch ID: 07952 CGST 9% `0.00
Vertex Customer Solutions India Private Limited
DSP ROAD NEAR RAVIDAS CHOWK FATEHABAD FATEHABAD HARYANA 125050 SGST 9% `0.00
IGST 18% `16.38
Total(Rounded Off) `107.00
GSTIN:27AAACN2082N1Z8 CIN: U72900MH1995PLC095642 SAC : 998319
For queries and information please contact: PAN/TDS Call Centers
020 - 27218080 020 - 27218081 tininfo@nsdl.co.in @NSDLeGovernance
Income Tax PAN Services Unit (Managed by NSDL)
5th floor, Mantri Sterling, Plot No. 341, Survey No. 997/8, Model Colony, Near Deep Bungalow Chowk, Pune – 411 016
If mobile no. is mentioned then you will receive SMS on status of your application.
You may track the status of your application using SMS facility – Type NSDLPAN<space>15 digit acknowledgement no. and send it to 57575 or by visiting our
website www.tin-nsdl.com.
You are also requested to provide feedback on your experience of PAN service at www.cleanmoney.gov.in
This is a computer generated receipt and does not require signature.
Online PAAM 1.2
Form No. 49A
Application forA!lotment of Permanent Account Number
fln the case of Indian Citizens/lndian companies/Entities incorpotated in lndia/
Unincorporated entities formed in Indial
See Rule llil
To avoid mislake (s). peas folrrylhe ac@mpanving inslruclio.s and eknples belore lilling !p lhe lom
Assessing otticer (Ao code)
Area code AO type Range code AO No.
t? W E q
Sir,
l,ryve hereby requestthat a permanent accounl number be allotted to me/us
l/!ve give below necessary partictilars:
initials are nol permitted)
I Full Name (Full expanded name to be mentioned as appearing in proof of identitytdate of birth/address documents:
Please selecl title, as applicable Smt.
E
Last Name / Surname
First Name
Middle Name
2 Abbreviations oflhe above name,.as you would like it, to be printed on the PAN card
I :1- ( R c I v l(tlr
3 Have you ever been known by any other name? f-l v"" El to (please tick as applicable)
lf yes, please give that olhername
Please setect title. as applicable
E
Last Name / Sumame
First Name
Midd'e Name
Gender (for Individual ap.plicants only) Vl ttt t" ! remat. I Transsender (please lick as applicable)
or Association of Persons
Date of Birth/lncorporation/AgreernenuPartnership or Trust oeed/ Formation of Body of individuals
Day Month Year
r;-r= r-T=l r. ItTi7r--l
lJlJl l()lJ I t\ tr.l td F-l
D€'tails of rPar€nts.(applicable'9nly for individual applicants)
Fathet's Name (Mandatory Even married women should till in {athet's name only)
n n
Lasl Name / Sumame
First Name ( A ,\/ J tI
l\4iddle Name
Mother's Name loptional)
Lasl Name / Sumame
Firsl Name
Middle Name
Setectthenameofeitherfathelormotherwhichyoumay|iketobeprintedonPANcard(selectoneonly}
{ln case no option is provided then PAN card will be issued with father's
name)
name Motheas name (Please lck as aqqlicable)
@tsather's
7 Addtess
Residence Address
Flat/ Room / Door/ Block No. R. a C) J T C
Name of Premises / Buildlng / Village s c\ ?
Road / Street / Lane/Posi ofiice ) M ) K I A
L fT
Area / Locality / Taluka/ Sub- Division a ti M t
Town/City/Districl I t: tl fr
State / Union Territory Pincode i Zrp code Country
taAR'jfitrztt -------ill s tlrl l-rilNf
Office Address
Name of ofrice
Flat / Room / Door / Block No.
Name of Premises / Building / Village
Road / Streel / Lane/Post Otfice
Area / Locality / Taluka/ Sub- Division
Town/City/oislrict
State / Union Tenitory Pincode / Zip code Country
Address for,communication Residence (Please lick as applicable)
Telephone Number & Email lD details
Couniry code Area/STD Code Telephone / Mobile number
+R q X () 3
Email lD MOilt)(nl) At kr \\\bD6.trv\ .r nr4
l0 status ot applicanl
Please selecl stalus,
I as aonlicable T Governmenl
ffitnoiuiau"t E Hindu undivided family ft Company ! eannerstrip rirm n Association of Persons
! lrusts E Bodyot Individuals n
LJ
LI LocalAuthorily Artificial Juridical Persons I Limited Lrabilily Partnership
Registration Number (for company, tirms, LLPS
In case of a person, who is required to quote Aadhaar number or th€ Enrolrhent lD of Aadhaar application form as per section 139 AA
Please mention yoUTAADHMR number (if allotted)
MDHAAR number is not
lf mention the enrolmenl lD
Name as peTMDHMR letter or
13 Source.of lncome P/ease setecf, as applicable
fl s"t.,y | ""0n",
o"'""
I I Income lrom Eusrness / Plolesslon Business/Pfofession coo. fI lFor code: Refer instructionsl I Incomefrom other sources
lll lncome from House property i lr-1f No in"o'"
14 Representative Assessee {RA)
Full name, address of the Representative Assessee. who is assessible !nder the lncome Tax Act in respect ol the person. whose partrculars have
been given in the columd 1-13.
Full Name (Full expanded name : initials a,e not permitted)
t---,
Please select tille, l1l as applicable
Last Name / Sumame
Firsl Name
Middle Name
Address
Flat / Room / Door / Block No.
Name of Premises / Building / Village
Road / Slreet I Lane/Post Ofilce
Area / Locality / Taluka/ Sub- Divisio.
Town/City/Oistrict
Siate / Union Territory Pincode
15 Documents submitted as Proof of ldentity Proof ofAddress (PoA) and Proof of Date oi Birth IPOB)
l.ryve have enclosed as proof of identily,
as proof ot address and as proof ot dale of birth.
lPlease refer lo the inskuctions (as specified in Rule 114 of l.l Rules, 1962) for list of mandatory cenified documenis to be submitled
as applicablel
lAnnexure A, Annexu.e B &Annexure C are to be used wherever applicable]
16 l^ve . lhe applrcant, |n the capacity of
do hereby declare thal what is stated above is irue to the best of my/our information ahd belief.
tr&]NDL KfiL&N F-"{\')-
Signature / Lefl Thumb lmpressron or
Applicanl 0nside ihe box)
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