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114 views4 pagesIlovepdf Merged
ILOVE
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/ 4
| Application Number: 1277037.
ANT TUTTI WA errr
ALOAS A ZOD 7 _|payment Date: [20/70/2024 Rs.72.00/-
| Application Source: [EWALLET - A- CSC & GOVERNANCE SERVICES INDIA LIMITED. |Application Date:[20/10/2024 _]|
user 1a:[2413221 10011 user Name: [247322710011
[PAN CARD MODE = e-PAN only, No Physical PAN Card [Application Made : Physical Appl
Form No. 438
Application for Allotment of Permanent Account Number
{in the case of indian Citizens! Indian Companies/ Entities incorporated in Indlal
Unincorporated entities formed in India]
Ascessing officer (AO code)
‘Area code AO type, Range code, AO No.
he pe ats[elo|[2
Marder
hereby request that a Permanent Accou
iow necessary parteuars
1 Full Name (Full expanded name to be mentioned as appearing in proof of identity/address documents:
Pease stctte [Jas appease [y] mi [Jot a is
farce Surene MI OINIOIAILT | H T
[MfeTHlelRialey | | | | |
u[D]D]t
2 Abbroviations ofthe above name, as you would lke
ME|HJE[R|A/B| |U[D/D|I[N |
CI TET TT rr yt i im
3. Have you ever been known by any other mame? oleae applicable)
[Ves apotcabie Oe Jemt kuna
TTT TT imma eae ane
[eshte | eee! 1 ]
CI ! TH cr
4 Gender (or individual applicanisonty) 7] Male Female JTansgender (ptease tck as appicabla)
5. Dats of Bithincorporation/AgesementPartnarship or Trust Dood! el _ er
Formation of Body of individuals or association of Persons: 2{6] [o[7) [2[oj1yo
6 Details of Parents (applicable only for individual applicants),
Whether materi @ single parent and you wish o appy for PAN by furishng the name of your mother onl? Yes[ _] No[y/] (please tick as appicable}
tyes, please fin mother's name in the appropriate space provided below.
Fathors's Name (Mandatory except where mother fs a single parent and PAN is applied by furnishing the name of mother only)
a
Pi)
Last Name / Suename (Mjo[Nn|D[Aa LETT LETT
(uli ielu TIN TT
©
Moe Name i LI
Mothars's Name (optional except where Mother i a Sino parent
ee EEE
TT a card fs
{ln.case no option is provided then PAN card wil be issued wi father’s name except where mothers single parent and you wish to spply for
PAN by furnishing name ofthe mother ony). [71
Select the name of eltheefaber or mother which you may ie
Father'siname [_] other's Nome inet mayrsthy
7
Address Lo |
Noneot Pence! acmg/vaoge MIOITICIATRLATRTAL TTT TTT
Road Stoot/LanaPost fies {RiATUTT Taree Lett
‘iva Locality Taal Sa iclHIAlK|D/ATHIA Cry
Toun / Cy /Distict (ntafotital TT TT ses
‘Stota/ Union Teton, ____ Pineade Zip code County Na
L_WwesT BENGAL T7l4]ti2ta{et | iN
(fice Adaress = = 7
Name a fice Trt il
Fat Room / Dae Bick A [4 f= : Ct |
| 1
ari of Protos / Bung itage esl |
oa | Svost/ Lave Post tion jetes es] PPE rrr =e EEE
Tie ET I ]
Residence office {Please tick as applicable)
8 Address for Communication
19. Telephone Number & Email ID detalis
County code __AvealSTD Code ‘etephone / Mabila numibe
fehl] [ lay | PEPE beret
emet1D [Escrmallickdigital@gmall.com
so stats of eppieant
Pedram — rics nnanntanny [Jeoneoy patenip Fm Asien ot Parcs
Tats ay nil Leatactety tliat enone ted bit Parretp
11. Registration Number (for company, fitms, LLPS et)
CLLLELITIT 111 Pale TL)
seers ase eae wl daar nolan Dot aca applet fom as per secton 184A
oar ereevon naounan nsnoer tatotes) (512 [47] (2[ 416] 6] [aTolal]
ornate rotate poate mention te enimenD of ahear appa fm
[NforTy TATPT TC[AT BI LTE] [Wiel Fi O11] 1 0] 2] 0] 2] 47 |
a por AADHAAR letrfcard or a8 perth En
uyelAle|
a
43. Source of income lease select, [7] as senicable
CD sats Income rom House property 7] toincome capital Gains
LE conta anes /Preson QuanePresen cede [_[] tor cat: LE teceme em oer sources
‘a Represontative Assessee (RA)
REPres ea a rine Repesetave Assssee, whos asses under ho Income Tax Actin respect ofthe parson, whose pris have
been given in the column 1-13,
Full Name (Full expanded name :inals are not permitted)
Zsi Jame. kumar
m[o[N[p]ale
Presse siete, [v7] apocablo
Lost Nome # Sumarse
al[t/i[B/u|p|p| rN
Fest Name
sate Nome
Across
Frat Room Deo Block No PL 7
nome of Premises Buldng/vitoge [Olt |LlalPlale
oad / Sree Lane/Post Ofce Rlalo[riale[e I
oa tocaty Pra suo-onsion [C]H|Ale|D[ALe[A
vin 1 City Disret fwlalo[zfa TL
ate Uren Teor weet Benoac (7\«{al2felel
45 Documents submited as Proof of ldantiy PON, Proof of Address (POA) and Proof of Date of Birth (O08)
senay anions [7 AADRAAR Card s8u64 BY —) a rat orcanty, MADHAAR Care is8u0d by UIOAT_]
as poet of earess and [AADHAAR Card Tested by UIDAT es proof o ato of eh
{Peace refer othe nsrcton (8 epecied Rua 114 of L, Res, 1982) fo it of andlor cried dcimnts fo be sur 38 sppicable
iponeure A, Ancense 8 & Amante C robe used wherver applsbal
te velALIBUDDIN MONDAL I), tie appicant in he capacity of REPRESENTATIVE ASSESSEE
co nereby data that what slated above fs ue tote best of myfour information and bee
Pisce: [RAUTARI
pomMyyyy
owe: [2fo[sto[2Tol2T« fesve Date 27022021
‘Government of Inia
Meherab Uasin Mondal
108: 2570772010,
Male
a oy
5248 2466 4016
Meherap vad in Mandal
ees oR a / AHA OL STATE MERIT
wer wert a |
He wen 15 A oT OA RE GAT