Acknowledgement Number: N- 881033171667471
Form NO. 49A
Only ‘Individuals’ Application for Allotment of Permanent Account Only ‘Individuals’
to affix recent to affix recent
photograph [In the case of Indian Citizens/lndian Companies/Entities incorporated in India/ photograph
(3.5 cm x Unincorporated entities formed in India] (3.5 cm x
2.5 cm) Under section 139A of the Income Tax act, 1961 2.5 cm)
To avoid mistake (s), please follow the accompanying instructions and examples before filling
Assessing officer (AO code)
Sign/ Left Thumb impression AREA CODE AO TYPE Range Code AO NO
MUM W 122 4
Sir, I/We hereby request that a permanent account number be allotted to me/us. Signature / Left Thumb Impression of
I/We give below necessary particulars: Applicant (inside the box)
1. Full Name (Full expanded name to be mentioned as appearing in proof of identity/address documents: initials are not permitted)
Please select title, as applicable Shri Smt Kumari M/S
Last Name/Surname MALKAR
First Name RONIKA
Middle Name HEMANT
2. Abbreviations of the above name, as you would like it, to be printed on the PAN card
RONIKA HEMANT MALKAR
3. Have you ever been known by other name?
If yes, please give that other name Yes No
Please select title, as applicable Shri Smt. Kumari M/S
Last Name/Surname
First Name
Middle Name
4. Gender(for individual applicants only) Male Female Transgender
5. Date of Birth/Incorporation/Agreement/Partnership or Trust Deed/ Formation of Body of individuals or association of Persons
Day Month Year
17/03/1997
6. Details of Parents (applicable only for individual applicants)
Whether mother is a single parent and you wish to apply for PAN by furnishing the name of your mother only? Yes No
(please tick as applicable)
If yes,please fill in mother's name in the appropriate space provided below.
Father’s Name (Mandatory except where mother is a single parent and PAN is applied by furnishing the name of mother only)
Last Name/Surname MOREKAR
First Name HEMANT
Middle Name MAGAN
Mother's Name (Optional except where mother is a single parent and PAN is applied by furnishing the name of mother only)
Last Name/Surname
First Name
Middle Name
Select the name of either father or mother which you may like to be printed on PAN card (select one only)
(In case no option is provided then PAN card will be issued with father’s name)
Father's Name Mother's Name (Please tick as applicable)
(In case no option is provided then PAN card will be issued with father's name except where mother is a single parent and you wish to apply
for PAN by furnishing name of mother only)
7. Address
Residence Address
Flat / Room / Door / Block GROUND FLOOR GULUSTAN BLD
Name of Premises / Building / AMBANI HOUSE
Road / Street / Lane/Post Office
Area / Locality / Taluka/ Sub- CUFFE PARADE
Town / City / District MUMBAI
State / Union Territory Pincode / Zip code Country Name
MAHARASHTRA 400005 INDIA
Office Address
Name of office
Flat / Room / Door / Block
Name of Premises / Building /
Road / Street / Lane/Post Office
Area / Locality / Taluka/ Sub-
Town / City / District
State / Union Territory Pincode / Zip code Country Name
8. Address for Communication Residence Office Please tick as applicable
9. Telephone Number & Email ID details
Country code Area/STD Code Telephone / Mobile number
91 8850241487
Email ID RONI.MOREKAR@GMAIL.COM
10. Status of applicant
Please select status, as applicable Government
Individual Hindu undivided family Company Partnership Firm Association of Persons
Trusts Body of Individuals Local Authority Artificial Juridical Persons Limited Liability Partnership
11. Registration Number (for company, firms, LLPs etc.)
12. In case of a person, who is required to quote Aadhaar number/ the Enrolment ID of Aadhaar application form as per section
Please mention your AADHAAR number (if XXXXXXXX8624
If AADHAAR number is not allotted, please mention the enrolment ID of Aadhaar application
Name as per AADHAAR letter/card or as per the Enrolment ID of Aadhaar application
RONIKA HEMANT MALKAR
13. Source of Income
Salary Capital Gains
Business/Profession [For Code: Refer instructions]
Income from Business / Income from Other sources
Income from House property No income
14. Representative Assessee (RA)
Full name, address of the Representative Assessee, who is assessible under the Income Tax Act in respect of the person, whose
particulars have been given in the column 1-13.
Full Name (Full expanded name : initials are not permitted)
Please select title as applicable Shri Smt Kumari M/s
Last Name/Surname
First Name
Middle Name
Address
Flat / Room / Door / Block
Name of Premises / Building /
Road / Street / Lane/Post Office
Area / Locality / Taluka/ Sub-
Town / City / District
State / Union Territory Pincode Country Name
15. Documents submitted as Proof of Identity (POI), Proof of Address (POA) and Proof of Date of Birth (DOB)
I/We have enclosed Photo identity Card issued by the Central Government or State Government or Public Sector Undertaking as proof of identity
Bank account statement/passbook (Not more than 3 months old from the date of application) as proof of address and
Birth Certificate issued by the Municipal Authority or any office authorized to issue Birth and Death Certificate by the Registrar of as proof of date of birth.
Birth and Death of the Indian Consulate
[Please refer to the instructions (as specified in Rule 114 of I.T. Rules, 1962) for list of mandatory certified documents to be submitted as
applicable
[Annexure A, Annexure B & Annexure C are to be used wherever applicable]
16 I/We RONIKA HEMANT MALKAR the applicant, in the capacity of Himself/Herself
do hereby declare that what is stated above is true to the best of my/our information and
belief.
Place MUMBAI
DD MM YYYY
Date 06/01/2020 Signature / Left Thumb Impression of
Applicant (inside the box)
