‘esroedgemers Nerv ocmsesrosexs MINT AM
‘Request For New PAN Card Or! And Changes Or Correction in
Permanent Account Numer (PAN)
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ead Instructors & "fr selecting boxes on let margin of his form,
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| -Full Name (Full expanded name tebe mentioned as appsaring In proot af enuylederees
Please select as appicable =] Shi El Sm C1 Kuman CL] WS
Last Nameisurname
Fist Name
idee Name
Name you would ike t printed nthe PAN card <
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[352 Detalls of Parente (Applicable only for Indlvidual Appeants) Res
Whether mother ies sing parent and you wish 1 apply for PAN by furnishing the name of yourmotner oni? Yes) No
Ityes,please il in mathere name in the appropriate space provided below. Ss
ease tek os applicable) Ss
ars hae hands except where maha i single parent and PAM is ppd by turishing he a of mote nt)
[Last NametSurmame “SAWAN.
First Name AM s
Middle Name
Hetner' Name (Options xcept whe TTA sa sings parent and PAN Ts applied Brig Te as of OTT ony
Last Nameisuename
Frat Name
Misc Name
Select the namo of ether Father or Mother which you may Theo be printed on PAN
‘i ease ro pton is provided,hen PAN Card wl be issued wih Father's Nama,