pee eee QUIEN) men we crc Payment Oate: ‘Application Souree: EWALLET ~ sort (272PRASOOTE ser Name: [27DESASOOIS PAN CARD MODE : Both physical PAN and @-PAN Gard [Application Mode ical Application Form No. 494 7 Application for Allotment of Permanent Account Number {in the case of indian Citizens’ Indian Companies! Entities incorporated in tia! Unincorporated entities formed in nia} Assessing officer (AO code} AO ype Ares code miw[sle Sir, We hereby request that a Pennanert Account ile gve below necessary particulars 1) Full Name Full expanded name to be ment zned 2s appearing in proof of identtynddress docuiients nae are hot permitted) Prease solect ti, [yas appicatie sm [fore [often [favs Las Name Saar MOND AIL) | jE ay a t “ + } Middie Name i 1 E pained. 2. Abbreviations ofthe above name, a you would ke it fo be printed onthe PAN card = [TANUS RT MOND AL (eee ia | t fener | I Tt 3 Have you over been known by any other name? ver [y]n0 (please tek 8 apical} eV loseepite sm sme fom ue ees ‘Lest Name Suma Pease st FirstName { [ see Name 4. Gender fr inividua applicants ony) waio [7] Female []ranagenaer (please ic se appliabie) omy mortar 5 Date of Bitvincorporation/AgreementiParnership or Tust Ded! Formation of Body of individual or association of Persons (2]4] [ol2} (2[oloj2 © Detatof Parent (appebie ony for inca potent), ‘Whether moter a sng pret nd ou wish © apy fo PAW by fisting the name of your mother ony’? Yes| —] No[e7] eae Sk as spptcai iyes, please Sin mater name nth apropiecpace proved bel Father's Name (endear except har moter el parr and PAN applied by fursshng the nae of moter ony) ast Name Fest Name Miccle Name Mothers's Name (optional except where mothars& single parent and PAN is applied by furnishing the name of wiothor iy) LastName / Sumame Fst Name Mice Name Select the name of ether father or mother wich you may fe foe pied Sn PAN Cad Ant aah (incase no apton is provides then PAN card wi be fssued wth father's name excopt whore mother i @ single pent and you wish to apply for PAN by fusing name ofthe mather only) 7 Address Residence Address Fiat Room! Doo Block No Name of Promises / Bulag / Vilage Road / Street Lane\Post her's ame Name asd pity fice Address ; a = + Name ot otiee ji Flat Room / Door Black No i + Name Poms Bug ape aa13 est (Please tick as applicable) ‘Area | Locality! Tika Sub- Division ‘own Cay Dstiet 2 Address for Communication 8 Telephone Number & Email 1D details, Area Code Teper steer mn Email iD [tanusrimondal59@gmail.com_ ‘0 satus of apptcat Pace ste sas, sinc MD naviat — Panes Fen Assocation of Perens ee ee peat sate Pons F~]Limied Litty Parnes 11 Roglstaton Number for company, LLP tc) = eee EE CELCL CLL ‘2 Gas of person, whol reuieda quo AhaarsumbeTta Enrtnnd bof Adan’ application oem as pe secon {204A Paavenenion our AADHAAR umber fatoted) [@[1]214] [0]3]4] 9] [519] 6 8] : A AADHAAR number net lot, lee mention he orrment iD of aor appcaton om sill uae omen roe ies os orcas _— inne mouse onary FP] none cana cons [i eercinam man sane | 1] peor [.] wammnomenes aperiae tower 6 Fullname, address of the Representative Assessee, who is assossible under the Incorne Tax Actin respect ofthe porson, whose parictas have eon given in the eotumn 1-13 | puma [Js LastName Sue Toy rene ito lat sas one xadees Fat Room Door Blok No Name of Probes Bung age oot Sret Lane Post fice fea est iba SDs Tom iy si Sil Union Too Inve nave encoses | AADHAAR Card 86d BY |: poor or dentay, AADHAAR Card a proof of address and [AADHAAR Card issued by UIDAT as proof of date of bith (Proase rofer tothe Inuctons (a6 spectied in Rue 114 of LT. Rules, 1962) for list of mandatory cared documents to bo submited as apricabe} [Annenure A, Annexure B & Annexure C are 10 be used wherever appcatie] 46 wwe TANUSRI MONDAL |. the appicant. inthe capacity of (HIMSELF/HERSELF ~~} so horosy dectaro tat whats stated above Is U0 to the bos of mylour intrmaton and bole. Pace Date