Copy to be kept with application ‘Tax Invoice cum Acknowledgement receipt of PAN Application (Form 49A) Fes oem UUATTMUTUTUINUTHT =m Applicant's Namo |KULDIP KIRITBHAI SOLANKI a pes frre a Dt pot in mmr hie San [SUATED Tee rH awe [Reiner =e oe er Oe Patan 1 [oti hae aera eamenmrtaetn| Gages | tas St aa 08 MAHADEV XEROX & CSC CENTER SH NO 5, WARD NO 38 NEAR HANUMANGI TEMPLE, — a Total(Rounded Off) 107.00 soneacoe cameuianicena [oo ae This is @ computor goneraled reccipt and does nol require signature, ‘Onine PAAM 1.2&, er EEE EYEE tee eae Form No. 494 Appliation for Allotment of Permanent Account Number [nthe case of Indian Citzensindian Companles/Entites Incorporated in India! (l Unincorporated entities formed in India} ‘Se Rua 16 Tomiie er aor te somganing racer and aoe bre giao ‘Asteasing ffcer (AO code) ‘area code ‘Rope | Rangecods | AONo. 7 TT LI sr, Le hereby request hat a permanent account umber be alloted to mel. We give below necessary particular: + ae a TE SE {1 Full Name (Full expanded name to be mentioned de appear in proof of identityidate of birtvadiress documents: Iie are not permitod) 3 My agpnnds ant Pome eet tte,[7]asanoteae [AS (Jom [Joma []e om Last Neme J Surname zi inne Fst Name vito x { gle Name iki ziTiBiniA t 2. Abbreviations ofthe above name, as you would ike to be printed on tho PAN card 0 Nic! Kl eltiP_ MzlAlcirig wiarcl | | LE l [ [TT ee ‘piese tian apaeable) Pescewoucte[VJeramicaie [Js [Jone (Jeunes Ce alee oe tt ; ot Ht | ‘Middle Name C li ma! 4 Gender (for individual appticants only) [te} ale Female “Transgender (please tick as applicable) |5 Date of Birtincorporation/AgreementPartneship or Trust Deed Formation of Body of indviduals or Association of Persons Month Your (ogi [212] Rlolols) 6 Detate of Parents (pniabl nl fr navi appa) (hot ober tiga pret an you wish ap fr PAN by hing the name of youre on? [_]vee [_] vo ess tise a peat) yeu eas in moto’ name nthe spropine apace prov blo Fathor’s Neme (Mandatory except where mothers single parent and PAN is apiled by furnishing the name of mother only ie ee eet Midge Name HiulplArri gin Alt other's Name (optional except where mother isa single parent and PAN Is. tantarisanete Cr t rman ust be name of her fae or rer wich you may ie fo bo piradan PAW card (See one ni) fatersrame. | [Mothers name (Pease ck a apical) {Urcaze no option is proved then PAN card wl be esued with father’s name except where mothers single parent ana you wish 10 By fumahing name of tre mother on. 7 Address Residence Address ppt for PAN Fa Room Dor ck fal ELeoey I I Name of Premises / Building / Village A. Hl u Road | Steet / LaneiPoet Offos, ol AID ea oxy oa! Sb Dison + &H ‘Town Cty Diet h I I o Stata Urion Tertony Pincode /Zip code County Name l PRAT Jab 4olol él IvpifiOffice Address Name of fice Fiat Ror Door / Black No, ‘Name of Premises Bulking / Vilage Road! Steet / LanePost fice ‘ea! Local Tlukal Sub Dison Town Cty Diack Stale Union Teniny ised /Zip Sods — Cowra 8 Aderess for Communication [Jester Ofce (Please tok as spplable) 9 Toephone Number & Email D deta t County nde Ars/STD Code Telephone / Moe nner [ 6 cols et Ena Li Ss x merit. Co) 10 status ofappicnt i Pease sic sts, [7] a8 appeabe ovement veavt — [_]Hinnadestonty [Coonan Parenti Fim [Ly asoston o Parone [ste 200 fIndvla Locatautroniy, .[] aris rida Pereons [=] Lind LsityParnerip ‘1 Registation Number lor company tims, LAPS ot 12 Incase ofa person whe is required to quote Aadhiaainbe or he Ervcient Daf Aadnaar apelin foros pe ection 138 AA Please mention yourAADHAAR num faoes) (8 [4 | [siglo MAADHAAR number sol aoe, plese nano na anrinan Df Asghar aptEoA To Name as per AADHAAR letter or card or as per th aha 1D of Aadhaar application form, lole iA wilt [ Ut | O17) (ett alt aR HAIL) Aimar Pease selec | av onpiable Salary captal Gans Incr rom Business Preesien_BusneeProtesson cose [[_] (For Code:Reterhstuctons] [| incre tom ote sources leo om Hove prope No coms 14 Representative Assossee (RA) Full name, adiess of the RepreseniatveAssessee, whois ascosstle under the Income Tax Ac espect othe person, whose particulars have ‘been ven inthe column 3-13. Full Namo (Full expanded name: iia are not permitted) Please slec tile [¥/]as appeable sm Last Namo / Suname First Name Mie Name Address Fal/ Roam / Door / lock No Name of Premises /Buitng / Vilage Road / Stoo Lane Post Offce ‘Area Locality Taluka! Sub- Division Town City /Dietit Stale Union Terry het Pireoia {15 Documents submited as Proof of lentty (POI), Proof of Address (POA) and Proof of Date of Birth (PO) le have encioses [ADA R 26 proof ofidenty, 1 1s proof of addr and as proof of date of bith [Pico refer othe instruc as specfed i la TH of, Rls, 1952) for Bt of mandatory cried documento be submited as applicable) TPenenureA, AnevuraB& AnnenueC 610 be used wherever epliate) 16 wel ZGLANEL KULDTP tw sopicant inne capaciy of [— to neveby declare thal wha slated stove is Fue To Wha Best of mylour information ané bole Mh PORT DG uAOT Place Toney ere acco ow Zlold7Zagy3) ‘ena eine| | i a iG To add gad Government of India MEMO eClObsceminumteealOrre Unique Identification Authority of India siriigot $3 ivan! Enrolment No.: 0648/00350/49734 MAAS dems ‘Solanki Kuidip Kirtbhal 1185, Axsharpark, Nati Road, kumbharvada, ‘TC: Bhavnagar, PO: Bhavnagar Station Road, ‘Sub District: Gariechar, District: Bhavnagar, State: Gujarat, PIN Code: Mobile: 70: 364008, 116008717 ALA VWeLLe eiot2 / Your Aadhaar No. : 4944 5985 8091 VID : 9114 7474 2537 1332 wal Buea, HLL VV HLL Government of India“ “se Res 4 a deh godtu BEeoud Solanki Kuidip Kirtbhi ‘eet ox€bWDOB: 05/12/2006 yew! MALE fous A oder wae 8, arse Heal wo aoe A. aa G1 ura asic Geen wwuUtseR wMaL EAR aisalgrion deeded Bib maevecd AGA [Aadhaor is proot of identity, not of ctizenship for date of birth It should be used with verification (online| futhentieation, or scanning of OR code foffine XML. 4944 5985 8091 Bee, HesL BNverninant of India AeA BAeris-qjtamns Solank! Kcbhal Bhupatbhal eat eft DDB: o1/0e/1535 we / Maig=—sStBsee. “Authority of ndia™ Address: S10: Solan f ia Bhuprbhal, 1185, FE areal aati ty Akshar, madhiya road, asi, et kumtavede, Bhavnagar, ‘agg Au Bs ates ee Bhavrsgar Sistion Reed, i Gujan, 364008 4 S 4127 2958 4110