/Application Number (A0BB431308 NVM nso ao a: Payment Date: [08/02/2024 Rs.107.00/- Aopleaon source EWALLET =A VICES NDIA NITED —]orpncauon one GSSEEOGE—| | User a:[632734630010 JUser Name-[ ] IPAN CARD MODE : Both physical PAN and e-PAN Card lication Mode : Physical lication if — = Form No. 494, Application for Allotment of Permanent Account Number [in the case of Indian Citizens/ Indian Companies! Entities incorporated in India Unincorporated entities formed in India] See Rule 14 ‘oarsmen lee acampanyy neces ng amen ee tng ee Assessing officer (AO code) | coor poo oe device Pete twl Ta Tel Tels | pag Geamhon Sy, nowy eu atc mere ssn Mmber be i bana | LiWe give below necessary particulars 4 Spr hare renin Full Name (Full expanded nae o be manned es Fete soc te [7 ]as pate LastName Sumame te Jn proof of identityladdress documents” initials are not permitiod) First Name sdte Name Have you ever been known by any other name? Pree sect te [7] poate Last Name/ Surname Fret Name a Name [ oS ender for nda applicant nt) [7] use [C]romale[]rraegender passe ek applica) Date of Birthvincorporation/Agreement/Partnership or Trust Deed! mene ver Formation of Body of indvidls or association of {1[5} [o]4) [2[ojo[7 Details of Parents (applicable only for individual applicants), ‘Whether materi single parent and you wish o apply for PAN by furishin the name ofyourmother onl? Yes{ _] No[y7] ineasetck as appicabe Iiyes please iin mothers namein te approptate space proved below. Fratherss Name (Mandatory except where mothers a single parent and PAN is aplied by furnishing the name of mother only) Last Name / Sumame {OLINJelsiH] [| | er [TT Fret Nac fee | | i | Mice Name | TTT Mother's Name oplonal except where moter gl parent in the name af mother only ast Name / Sumame = I I 7 L] Mile Name 2 Scie te name ofthe ater or mother Which yOu may Re Re pind On PAN Ear ota oe wi (incase no options provided then PAN card willbe issued wit father’s name except where materia single parent and you wish o appl for PAN by fuishng name ofthe mather on) [¥7] eather nama etl fas vw ] Mothers Name criss Residence Address 7 — Ro Do lok No EtstHt Tc | Name of Promises / Bulging / Vilage HIATS. ah Road Steet Lane/Post Offes Ri_IMITR 1h ‘rea i Locality | Taluka” Sub- Division T psf UTTAR Otic Rares Fla: Room /Doot Block No. Name of Premises / Bung Vitage oat / Svest/Lane-Post Ofice— id - 8 9 10 Status of appiicant 12 In Gase of a person, who is required to quote Aadhaar numberiThe ‘Nea Locality Taluka Sub-Dvsion + - Town (ky / Distt ‘Address for Communication [V] residence tte (Please tick as applicable) lephone Number & Email ID details County code ArealSTD Code sf] O.TITT CO bre Smal 0 [OSSGHOSH@GMAIL.COM Prete vlc siaus, [Jon aptcstie [Joorenmant 7] vent Hacs veto amy [_Jeompony Padma [Li cooston ot erona its 4 [Tey fig Leal Ashsty Joa src! Persons []Lante uaity Paes Registration Number (for company, firms, LLPS etc.) TTT TTT EPP rt Tt Enrolment ID of Aadhaar application form as per section 139AA ease mention your AADHAAR number (f alloted) [9 [2 | 8 | 2 5]7/5|2] [s[ole| 6] AAOHAAR number is not alloted, please mention the enrolment ID of ‘Aadhaar application form "ame a8 per AADHAAR lettericard or as per the Enrolment ID of Aadhaar appicalion form HAIN [sry T RIA| Vit] |e[HlAlU Cees LL z 13. Source of income CD saay Income from House property ‘Income trom Business / Profession Business/Prafession code ‘4 Represent 15 Documents submitted as Proof of Kdentity (PO), Proof of Address (POA) and P Uwe have eneiosea | AADHAAR Card issued BY — | 9s prot of igentty, AADHAAR Card issued by UIDAT | Pease select, [V/] as applicable No income Capital Gains Assessee (RA) Ful name. adaress ofthe Representative Assessee, who is assessible ‘been given in the column 1-13. Full Name (Full expanded name: initials are not permitted) Fe cserraneriictony [_] walid a Gb ic "under the Income Tax Actin respect of the person, whose particulars have. Please soot te [Yas appicasa [w]em [Jam [Truman [Jue st Name Suame D/z[Nyels[al | | Name | I oe Name feet Address Fiat Room / Door / Block No, ° s[plal x lajilelu ols|z Nam of Promises’ Buleing / Vilage Road / Street / Lane/Post Ofoe ‘area ! Locality (Taluka Sub- DWvsion cay Dieriet U a]alé|p|z[s|a Hjals R[ [wjt[R|aja State / Union Tetny UDERA RP RADE SH |2/7/5/2]0[5| |Pincote ‘of Date of Birth (008) 25 poet of ascross ane AADHAAR Card issued By UIDAT [Please refer lo he instuctons (as speciiad in Rule 114 of 1, Rules, 8 proof of date of bith, 1962) fr list of mandatory certifed documents to be submied a8 appicable} [Annexure A, Annexure B & Annexure C ae o be used wherever applicable] toe CHAUHAN RAVI). tne apocant, in ne capacty of AINSELFIHERSELF ‘fo hreby declare that what is stale above is rue to the best of myiou 1 iolormation and belie Pisce GHOSI MAU gor rar Signature / Left Thumb impression of Applicant (nse the box)Dinesh sre ftv DOB: 0101/1988 yet) MALE