Application Number: U-N006510910
Application Number Bar Code Payment Reference: ZHD51771702782 Inward Number Bar Code
Payment Date: 2024-02-23 17:14:27 Rs.71.90/-
Application Source: UTIITSL WEB-SITE Application Date: 23/02/2024
User Id: INTERNET USER User Name: INTERNET USER
PAN CARD MODE : e-PAN only, No Physical PAN Card Application Mode : Digital Application (e-KYC)
D L C W X 2 6 9 1
eKYC-Application
✔
J H A R I Y A
V I N O D
V I N O D J H A R I Y A
0 1 0 1 1 9 7 8
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)
J H A R I Y A
M A K H 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) ✔
S / O : M A K H A N V I L L A G E
R A N A G A N W P O S T S H A N G R A M P U R
S H A H P U R A S H A H P U R A
S H A H P U R A N I W A S D I N D O R I
M A D H Y A P R A D E S H 4 8 1 9 9 0 I N D I A
✔
9 1 9 6 9 1 4 8 9 3 5 7
shikhajhariya1@gmail.com
5 4 0 8 4 4 5 6 2 2 9 3
V I N O D J H A R I Y A
AADHAAR Card issued by UIDAI (In AADHAAR Card issued by UIDAI (In Copy)
Copy)
AADHAAR Card issued by UIDAI (In Copy)
VINOD JHARIYA HIMSELF/HERSELF
SHAHPURA
eKYC-Application
2 3 0 2 2 0 2 4
Enrolment No.: XXXX/XXXXX/XXXXX
Download Date:23/02/2024
To
Vinod Jhariya
S/O: Makhan
Post Shangrampur
village Ranaganw
VTC: Shahpura
PO: Shahpura Niwas
District: Dindori
State: Madhya Pradesh
PIN Code: 481990
Issue Date:20/12/2013
Signature Not Verified
Digitally signed by DS
UNIQUE IDENTIFICATION
AUTHORITY OF INDIA 04
Date: 2024.02.23 17:17:30
IST
5408 4456 2293
Download Date:23/02/2024
Vinod Jhariya Address:
Issue Date:20/12/2013
ज म ित थ/DOB: 01-01-1978 S/O: Makhan, village Ranaganw, Post
Shangrampur, Shahpura, PO:
पु ष/ MALE Shahpura Niwas, Dist: Dindori,
Madhya Pradesh, 481990
5408 4456 2293 5408 4456 2293
Signature Not
Verified
Signed by :VINOD JHARIYA
Date : 23/02/2024 17:25:03
Reason : eSign Service
Location : India
