Application Number:A095379701
Payment Reference:4177115224326182 / PY0133620206
JPayment Date: |25/06/2024 Rs 107.00/
Application Date:25/06/2024
|Application Source: EWALLET -A- CSC EGÖVERNANCE SERVICES INDIA LIMITED
User ld:|275437250012 JUser Name:(275437250012
hphysical PAN and e-PAN Card Application Mode: Physical Appl
Form No. 49A
Application for Allotment of Permanent Account Number
[In the case of Indian Citizens/ indian Companies/ Entities incorporated in Indial
Unincorporated entities formmed in India)
See Rule 114
fHling up fhe furm
To avod miatakes please tollo th acompaying instructons and ex amples before
Assessing officer (AO code)
Range code AO No.
Area code A0 type
A R W 72 3
Sir, IWe hereby request that a permanent Account Number be allotted to melus.
Sashanth
IWe give below necessay particulars Sanatureteft Thuntb irnprassion
mentioned as appearing in proof of identityladdress documents: initials are not permitted)
1 Full Name (Full expanded name to be
Shri Smt. Kumari M/s
Please select title, as applicable
Last Name Surname SRI SHA NTH REDDY
First Name MAA REDDY
Middie Name
Abbreviations of the above namne, as you would like it, to be printed on the PAN card
MA AREDD Y SRISHA NTH RE DDY
Have youever been known by any other name? Yes NO (please tick as applicable)
3
H yes please give that other name
Piease seiect title.as applicable Shri Smt. |Kumari Mis
Last Name / Surname
First Name
Middle Name
4 Gender (for Individual applicants only) Male Female Transgender (please tick as applicable)
Day Month Year
Date of Birth/IncorporationlAgreement/Partnership or Trust Deed/ |18 052o 06
Formation of Body of individuals or association of Persons
6 Details of Parents (applicable only for individual applicants),
tick as applicable)
Whether mother is a single parent and you wish to apply for PAN by furnishing the name of your mother only? YesNo(please
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)
Last Name / Surnarne SUDHAKAR |REDDY
First Name MAA REDDY
Middle Name
Mothers's Name (optional except where mother is a single parent and PAN is applied by furnishing the name of mother only)
Last Name / Surname
First Narne
Middie Narme
card (seleut ome nly)
Select the name of either father or mother which you may like to be printed on PAN
(In case no option is proyided 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)Father's name Mother's Name (Plcase ick as upplicable)
Address
Residence Address
2 59
Flat / Room / Door / Block No
Narne of Premises /Building /Village
ATNo|LE
A|NoLE
Road/ Street / Lane/Post Office
Area /Locality /Taluka/ Sub- Division |ACHA MPET
Town /City / District MAHABUB NAGAR
Slate / Union Territory Pincode lZip code Country Name
TEL ANG ANA
Office Address
|5 |o |9 |3|7|5| |N D | A
Name of office
Flat / Room / Door Block No.
Nanne of Premises / Building / Village
Road / Street / LanelPostOffice
AreaiLocality /Taluka Sub- Division
IA Town / City / District
office (Please tick as applicable)
Address for Communication
9 Telephone Number & Emait lD details
|VResidence
County code Area/STD Code
Telephone /Mobile number
91 98483521 14
Email !D
k00110982 @gmail.com
10 Status of applicant Government
Please select status, as appicable
Association of Persons
Individual Hindu undivided family JCompany Partnership Firm
Limited Liability Partnership
Local Authority Artificial Juridical Persons
Trusts Body of lndividuals
11 Registration Number (for company, firms, LLPs etc.)
application form as per section 139AA
person, who is required to quote Aadhaar number/The Enrolment ID of Aadhaar
12 in Case of a
) 6 5 2 8 |5 6 7 o 9 4 8 6|
Please mention your AADHAAR number (if allotted
mention the enrolment ID of Aadhaar application form
if AADHAAR nUmber is not allotted, please
Enrolment ID of Aadhaar application form
Name as per AADHAAR ietter/card or as per the RED D Y
MAARED DY sRI|sHANTH
Please select, v as applicabie
13 Source of Income
No income
Capital Gains
Income from House property
Salary Income from Other sources
Business/Profession code [For Code: Refer instructions]
Income from Business / Profession
14 Representative Assessee (RA) of the person, whose particulars have
who is assessible under the Income Tax Act in respect
Full name, address of the Representalive Assessee,
been given in the column 1-13.
Full Name (Fullexpanded name: initials are not permitted)
Piease select title. | a s applicable VShri Smt. KumariWs
sUD H A KA R RED D Y
Last Name / Surname
First Narne
MA A RE
Middie Name
Address
Flat / Room / Door / Block No. 2 59
Name of Premises / Building / Village A I NO LE
Road / Street / Lane/Post Office AI NOLE
Area /Locality / Taluka/ Sub- Division A C HAM
Town / City /District MA H AB UB AGA R
State / Union Territory TE LA N GA NA 9375 Pincode
Proof of Date of Birth (DOB)
15 Documents submitted as Proof of ldentity (POI), Proof of Address (POA) and
by UIDAI
IWe have enclosed
AADHAAR Card issued by as proof of identity.AADHAAR Card issued
Card issued by UIDAI as proof of date of birth.
as proof of address and AADHAAR
certified documents to be submitted as applicablel
[Please refer to the instructions (as specified in Rule 114 of |.T. Rules, 1962) for list of mandatory
[Annexure A, Annexure B &Annexure C are to be used wherever applicable)
16 IMeMAAREDDY SRISHANTH REDDY HIMSELFIHERSELF
the applicant, in the capacity of
do hereby declare that what is stated above is true to the best of my/our information and belief.
AINOLE
M. Saishanth
Place
DDM M Y Y Y Y
Date
2|5|06|2 ]0 |2|4) Signaturel Left Thumb Impression of Applicant (inside the box)
Ppllcatir
Ser!
AADHAAR
34TT Government of India
oarGos» / INFORMATION
Government of India
Unique ldentification Authority of India
S 5 / Enrolment No.: 2081/11119/26883
To
Maareddy Srishanth Reddy
S/O: Maareddy Sudhakar Reddy.
2-59,
VTC: Ainole.
PO: Inole. e6beá ododTsT mAadhaar ar5á) G5& Ssc.
Sub District: Achampet,
District: Mahabubnagar.
State: Telangana,
PIN Code: 509375,
Mobile: 9848352114 Aadhaar is proof of identity, not of citizenship or date of birth (DOB). DOB
is based on information supported by proof of DOB document specified in
regulations, submitted by Aadhaar number holder.
This Aadhaarletter should be verified through either online
authentication by UIDAl-appointed authentication agency or QR code
scanning using mAadhaar or Aadhaar QR Scanner app available in
app stores or using secure QR code reader app available on
www.uidai.gov.in.
Aadhaar is unigue and secure.
Signatureyalid D Documents to support identity and address should be updated in
Aadhaar after every 10 years from date of enrolment for Aadhaar.
11 t5
Aadhaar helps you avail of various Government and Non
Govenment benefits/services.
S e9g5 3 o /Your Aadhaar No. : Keep your mobile number and email id updated in Aadhaar.
Download mAadhaar app to avail of Aadhaar services.
6528 5670 9486 Use the feature of Lock/Unlock Aadhaar/biometrics to ensure
VID : 9166 8908 1285 9837
security when not using Aadhaar/biometrics.
Entities seeking Aadhaar are obligated to seek consent.
Government of India Unique ldentification Authority of india
s/O: Srö äprs× a. 2-59, aC*8, ase,
JárariSh6,
Maareddy Srishanth Reddy
es dbIDOB: 18/05/2006 geores - 509375
yos/ MALE Address:
S/O: Maareddy Sudhakar Reddy, 2-59,
öAinole, PO: Inole, DIST: Mahabubnagar,
Telangana - 509375
Aadhaar is hitenty,
proof of f not of citizenshin
ar date of .It should be used with verification (online
authentication, or scanning of QR code / offline XML).
6528 5670 9486
6528 5670 9486
VID:9166 8908 1285 9837
1947 olp @uidai.gov.in | CD www.uidai.gov.in
