Form No.

49A
Application for Allotment of Permanent Account Number
Only Only
'Individuals' [In the case of Indian Citizens/Indian Companies/Entities incorporated in
'Individuals'
to affix recent India/Unincorporated entities formed in India] to affix recent
photograph See Rule 114
photograph
(3.5 cm * To avoid mistake (s), please follow the accompanying instructions and examples before filling up the form
(3.5 cm *
2.5 cm) Assessing officer (AO code) 2.5 cm)

Area Code AO Type Range Code AO No

Signature/Left thumb impression

across this photo PAN - Application/Coupon No.:U-
Payment Ref.No.& Amt : Rs.

Sir, I/We hereby request that a permanent account number be allotted to me/us.

RM
I/We give below necessary particulars: Signature/Left Thumb Impression
1 Full Name (Full expanded name to be mentioned as appearing in proof of identity/address documents: initials are not permitted)
Please select title, þas applicable ¨ Shri þ Smt. ¨Kumari ¨ M/s
Last Name/ Surname M A N K A R
First Name K A S A B A I
Middle Name U T T A M
2 Abbreviations of the above name, as you would like it, to be printed on the PAN card
K A S A B A I U T T A M M A N K A R

FO
3 Have you ever been known by any other name? ¨ Yes þ No (please tick as applicable)
If yes, please give that other name

Please select title, þas applicable ¨ Shri ¨ Smt. ¨Kumari ¨ M/s

Last Name/Surname
First Name
Middle Name

4 Gender (for Individual applicants only) ¨ Male þ Female ¨ Transgender (please tick as applicable)
5 Date of Birth/Incorporation/Agreement/Partnership or Trust Deed/ Formation of Body of individuals or association of Persons
EW
Day Month Year

0 1 0 1 1 9 4 8

6 Details of Parents (applicable only for Individual applicants),

Whether mother is a single parent and you wish to apply for PAN by furnishing the name of your mother
only? ¨ Yes þ No (Please tick as applicable)

If yes, please fill in mother’s name in the appropriate space provide below.
Father's Name(Mandatory except where mother is a single parent and PAN is applied by furnishing the name of mother only)
Last Name/Surname K A K F A L E
VI

First Name K O N D I B A
Middle Name
Mother,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 Name
E

Middle Name
Select the name of either father or mother which you may like to be printed on PAN card(select only one)
(In case no option is provided then PAN card will be issued with father's name) þ Father's name ¨ Mother's name (Please tick as applicable)
PR

7 Address
Residence Address
Flat / Room / Door / Block No. M A H O R A 0 1
Name of Premises / Building / Village M A H O R A
Road / Street / Lane/Post Office A T P O S T M A H O R A
Area / Locality / Taluka/ Sub- Division T Q J A F R A B A D
Town / City / District A T P O S T M A H O R A
State/Union Territory Pincode / Zip code Country Name
MAHARASHTRA 4 3 1 2 0 6 INDIA
Office Address
Name of office
Flat / Room / Door / Block No.
Name of Premises / Building / Village
Road / Street / Lane/Post Office
Area / Locality / Taluka/ Sub- Division
Town / City / District
State/Union Territory Pincode / Zip code Country Name
8 Address for Communication þ Residence ¨ Office (Please tick as applicable)
9 Telephone Number & Email ID details
Country code Area/STD/Code Telephone/Mobile number
0 2 4 8 5 9 5 6 1 3 6 0 2 0 1

Email ID ashwiniyash52@gmail.com
10 Status of applicant

Please select status, þas applicable ¨Government

þIndividual ¨Hindu undivided family ¨Company ¨Partnership Firm ¨Association of Persons

RM
¨Trusts ¨Body of Individuals ¨Local Authority ¨Artifical Juridical Persons ¨Limited Liability Partnership
11 Registration Number(for company,firms,LLPs etc.) Signature/Left Thumb Impression of Applicant(inside the box)

12 In Case of a person,who is required to quote Aadhaar number/The Enrolment ID of Aadhaar application form as per section 139AA
Please Mention your AADHAAR number(if alloted)

If AADHAAR number is not alloted,please mention the enrolment ID of Aadhaar application form

FO
Name as per AADHAAR letter/card or as per the Enrolment ID of Aadhaar application form

13 Source of Income
Please select, þas applicable
þSalary ¨Capital Gains
¨Income from Business/Profession Business/Profession code [For Code:Refer þIncome from Other source
EW
instructions]

¨Income from House property ¨No income

14 Representative Assessee (RA)
Full name, address of the Representative Assessee, who is assessible under the Income Tax Act in respect of the person, whose particulars have been
given in the column 1-13
Full name (Full expanded name : initials are not permitted)

Please select title þas applicable ¨ Shri ¨ Smt. ¨Kumari ¨ M/s

Last Name/Surname
VI

First Name

Middle Name

Address
Flat/Room/Door/Block No.
Name of Premises/Building/Village
E

Road/Street/Lane/Post Office
Area/Locality/Taluka/Sub-Division
Town/City/District
PR

State/Union Territory Pincode

15 Documents submitted as Proof of Identity (POI),Proof of Address (POA) and Proof of Date of Birth (DOB)
AADHAAR Card issued by UIDAI (In Copy) AADHAAR Card issued by UIDAI (In Copy)
I/We have enclosed as proof of identity,
AADHAAR Card issued by UIDAI (In Copy)
as proof of address and as proof of date of birth.
[Please refer to the instructions (as specified in Rule 114 of I.T. Rules, 1962) for list of mandatory certified documents to be submitted as applicable]
[Annexure A,Annexure B & Annuxure C are to be used wherever applicable]

16 I/We KASABAI UTTAM MANKAR ,the applicant, in the capacity of HIMSELF/HERSELF

do hereby declare that what is stated above is true to the best of my/our information and belief.

Place : MAHORA
D D M M Y Y Y Y
Date : 3 0 1 1 2 0 2 4