Application Number: A091260511
Application Number Bar Code 4088131725829444 / PY0127571686
Payment Reference: Inward Number Bar Code
Payment Date: 28/03/2024 Rs.106.90/-
Application Source: EWALLET - A - CSC E GOVERNANCE SERVICES INDIA LIMITED Application Date: 28/03/2024
User Id: 637716370016 User Name: 637716370016
PAN CARD MODE : Both physical PAN and e-PAN Card Application Mode : Digital Application
K N P W 8 5 9 1
eKYC-Application
✔
S I N G H
R A G H V E N D R A
R A G H V E N D R A S I N G H
1 6 0 7 2 0 0 4
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.
Fathers’s Name (Mandatory except where mother is a single parent and PAN is applied by furnishing the name of mother only)
K U M A R
S H R A V A N
Mothers’s Name (optional except where mother is a single parent and PAN is applied by furnishing the name of mother only)
(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 the mother only) ✔
C / O : S H R A V A N K U M A R
J I R K H A P U R K A I M G A N J
L E H R A
K A I M G A N J
F A R R U K H A B A D
U T T A R P R A D E S H 2 0 9 5 0 2 I N D I A
✔
9 1 8 3 5 5 0 4 2 0 3 6
rsinghy216105@gmail.com
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R A G H V E N D R A S I N G H
AADHAAR Card issued by AADHAAR Card issued by UIDAI
UIDAI (In Copy) (In Copy)
AADHAAR Card issued by UIDAI
(In Copy)
RAGHVENDRA SINGH HIMSELF/HERSELF
KAIMGANJ
eKYC-Application
2 8 0 3 2 0 2 4
Enrolment No.: XXXX/XXXXX/XXXXX
To
Download Date:28/03/2024
Raghvendra Singh
C/O: Shravan Kumar
VTC: Jirkhapur
PO: Lahra
District: Farrukhabad
State: Uttar Pradesh
PIN Code: 209502
Issue Date:09/05/2015
Signature Not Verified
Digitally signed by DS
UNIQUE IDENTIFICATION
AUTHORITY OF INDIA 04
Date: 2024.03.28 13:19:24
IST
2921 9843 9936
Raghvendra Singh Address:
Download Date:28/03/2024
C/O: Shravan Kumar, Jirkhapur, PO:
ज म ित थ/DOB: 16-07-2004
Issue Date:09/05/2015
Lahra, Dist: Farrukhabad,
पु ष/ MALE Uttar Pradesh, 209502
2921 9843 9936 2921 9843 9936
Consent Form Aadhaar holders
Biometric and/or OTP based eKYC and Aadhaar Authentication
PAN/ApplicationNo.:
A091260511
Name as per PAN card:760255072247
RAGHVENDRA SINGH
Aadhaar number: xxxx-xxxx-9936
Name as per Aadhaarcard: RAGHVENDRA SINGH
Declaration:
I do hereby confirm that the Aadhaar given above has been issued to me by UIDAI. As a
part of process, the Aadhaar/eKYC data may be used only for the requirement of PAN
allotment.
I state that I do not have any objection in authenticating myself with Aadhaar based
authentication system and I hereby provide my consent to use my Aadhaar number,
Biometric and/or One Time Password (OTP) data for authentication for the purpose of
fulfilling the requirement under PAN process.
I understand that the Biometric and/or OTP provided for Aadhaar authentication /
eKYC data shall be used only for authenticating my identity through the Aadhaar
Authentication system for the purpose of only PAN allotment process.
This is further acknowledged that while submitting through Change Request Form in
PAN data. If in case, Aadhaar is not linked with PAN then through this process
Aadhaar will not be linked with PAN i.e. will be used for authentication /eKYC
purpose only.
I understand that complete security and confidentiality shall be ensured for my personal
identity data provided for the purpose of Aadhaar based authentication.
Date 28/03/2024 Signature / Thumb Impression
Signature Not
Verified
Signed by :RAGHVENDRA SINGH
Date : 28/03/2024 13:26:42
Reason : eSign Service
Location : India
