Form No. 494 ‘Application for Allotment of Permanent Account Number [in the case of Indian Citizens/indian Companies/Entities incorporated fn india! ‘Soe Re 114 “nen me (seus tow the cerned em br eg 8 eo Assessing officer (AO code) ‘Area code ‘AOtype | _ Range code ‘AONS. I I —————— -& . T5 Sal oe prey request that a permanent account number be lcd to meh. te give low necessary parca: 41 Full Name (Full expanded name oe mentioned a8 appearing i proof Pease sateen [7]os appcatte [Jom [Jom [_|iuman [7] Last Name Sumarne Fest Nome ] {4 TT Pele ves [_]no. (please tick as applicable) sre [tomes] ate] Femate ‘Transgender (please tick a8 applicable) |S. Date of Bithmncorperation/AgreementPartnership o Trust Deed Formation of Body of individuals or Associaton of Persons eh Taw 3] 012) Glee 6 Details of Parents (applicable only for individual applicants) ‘Whether mother isa single parent and you wh 10 apply for PAN by fumishing the name of your mother onty? |ves [Y]No (please tick as applicable) Tiyen nese fin mothers name ne apprpste space roe eon oe cen exept where mathe ls ingle parent and PAN sapped by furshing the name of mother ont Last ame /Sumame cycA Fst Nome de Name ‘Selec! the name of ether father or mother which you may ke tobe pistad on PAN cad (Select one only) Fiber’ rare IMcthersname (Please tick as applicable) (incase no etn prov han PAN card Wie ue with fers name except whore mothers ig pare nd you wi py er PAN by turmishing name ofthe masher ont) 1 Address Residence Address Fat Room Dor Bock No. Name of Premies / Bung / Vane RITINIDIAL ELAN |PLY. Road | Steet | Lane/Post Ofice D NTP] ul ea Loca Tabkal Sib Ovesen (UL LUI Ef Town yet RAH sia / Union Terry Picode /Zp cove Gouty Nome [ AIST IN DEAN J‘Oilce Aeros Nome of otce Flat! Room / Door Biock No. Nome of Premes / Busting /Vitoge ‘Road /Sreat/LanelPost Ofico ‘ea | Locaty | Takia! Sfp Drision “oun Cy /Disic. ‘Slate I Union Tenftory 8 Address tor Communication a ey ‘Bi 12 Incase of» person, who is required to quote Asdhsar umber or the Enrolnent 1 of Aadhaarappticalion form as per section 139.AA S Please manson your AADHAAR number @ toned) [3] 2] 9]5191 3! [S418 1S] 4) WAADHAAR ruber ie not stad, passa mention the encirset ID KIRIA [Tu ene et of Racha Name as per AADHAAR letior af card oF 3 per the Enrciment ID of Aadhaar 19, source oftcame Pass sect [ v7] as opcble [U sotory Capital Gains Ince tom Busines Psion saosin cade [[] (Frcote: Raters) [7 incon tom er cas ime ees ment Noneome 14 Representative Assessee (RA) Fullname, address of the Representative Assessze, who is assescible under the Income Tax Actin respec ofthe person, whose pariculars have ‘been given in the ealumn 1-13. Full Name (Ful expanded name : initials are not permitted) eae secttt(VJansensce [soa [sm []hirmat [Jule Liteon co Ft Nae ete Name Address: Flt oom Dor / ck Mo. Name of Promizes king! Wage Rood Set Lanes ce ea toca Tk Sb-on Tow ty Dit —— ae i} 115 Documents submitted as Proof of Kdentty (PON, Proof of Address (POA) and Proof of Date of Birth (POB) ee enna pod ida oot of aseress and pool dat cb Fewer tos (or ped as 147 Fle Tr at of many core eerste apa Demonte hmenreB&ferene C eto be sed where ewe 16 wel RASWA —[HATUN |]. ve opicon. inte cpscty ot [IM SEIF HERSELF] ‘do hereby declare Pel wail stated above i we t the best of mylour information and bell. rae: [HOW RAM THM olga DoOMMY vy y ‘Sars Lat Than epson owe [o[S]2]3]2]6 1214) eel "Nae Ae por prions f Secon 272 of a ncome Tax At, 1961, a penal of 10,000 can beloved on possession of more an one PAN.3 a Rd HER ketene eae eet isitacaecigmceroy ited cuicencnea tea Enrofiment No.: 2834/08054/07931 GATT SATU SHIR / Your Aacivaar No. : 3255 9819 4894 au sien, AR geet 3255 9819 4894 INT Ter, AY sare 2m Big g — i AADHAAR a S STETE GREY ewe, Sra a ah 1 8 Fic on ahs (sire ea Sie aes 3 arr sis | [ae wl 15 FG Sa OF ae Ge) Laer srt INFORMATION ® Aadioar i a proof of identity, not of tizenship. ' Venty identity using Secure OR Code / tine XML / Sri saertat — Late reotenteet, = spun ag ment stk Ak ead Gast OFT Sar Fra 8 | oa 9 sage ax sik at w sede ai © Free a ot ene eS maar: ara on attaining 15 years of age need io | © Aachaar is valid throughout the county. "= Aachaar helps you avail various Government and services easily. "= Keep your mobile number & email 1D updated fn Aadhaae. "© Carry Aadhaar in your smart phone use mAadhear App. For Pan Purpose Only2apracts » Sree ae stent You Ahan 6830 9946 5909 | SNS — WARM Aa afters ee Father SayesAt Mota ete D08 evens? Mae ek a ie BAC aA Ai]of) pats / = AM ey a oe aoa set, amikeuR sae ARI 9 Beas sar aes Sate FI AS seal INFORMATION ‘= Aadhaar is proof of identity, not of cilizenship. '® To establish identity, authenticate online. } Le xi sa one ATH [a aR ofan saa ¢ core afc fi Ue XT j | |m Aadhaar is valid throughout the country. ||: Racinaar wade heipflin availing Government | +)” and Non-Government services in future. 6830 9945 5909 —————— eS c=, cE} =) ee For Pan Purpose Only