Application Number: U-N007197990
Application Number Bar Code Payment Reference: ZHD5YHY0538NOH Inward Number Bar Code
Payment Date: 2024-11-12 17:44:48 Rs.106.90/-
Application Source: UTIITSL WEB-SITE Application Date: 12/11/2024
User Id: INTERNET USER User Name: INTERNET USER
PAN CARD MODE : Both physical PAN and e-PAN Card Application Mode : Digital Application (e-KYC)
L K N W 2 3 9 4
eKYC-Application
✔
V I S H W A K A R M A
S H U B H A M
S H U B H A M V I S H W A K A R M A
0 8 1 2 2 0 0 4
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)
V I S H W A K A R M A
S A T I S H
K U M A R
Mothers’s Name (optional except where mother is a single parent and PAN is applied by furnishing the name of mother only)
D E V I
S A N G E E T A
(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) ✔
C / O : S A T I S H K U M A R
V I S H W A K A R M A B A G H E R A
B A G H E R A C H U N A R P U R U S O T T A M
P U R M I R Z A P U R
U T T A R P R A D E S H 2 3 1 3 0 5 I N D I A
✔
9 1 8 1 1 2 8 0 0 3 9 3
ssatishvishwakarma32@gmail.com
4 8 2 3 5 2 0 9 5 8 1 6
N O T A P P L I C A B L E W E F 0 1 1 0 2 0 2 4
S H U B H A M V I S H W A K A R M A
AADHAAR Card issued by AADHAAR Card issued by UIDAI
UIDAI (In Copy) (In Copy)
AADHAAR Card issued by UIDAI
(In Copy)
SHUBHAM VISHWAKARMA HIMSELF/HERSELF
NAI BASTI BAGHERA
eKYC-Application
1 2 1 1 2 0 2 4
Enrolment No.: XXXX/XXXXX/XXXXX
To
Download Date:12/11/2024
Shubham Vishwakarma
C/O: Satish Kumar Vishwakarma
baghera
VTC: Baghera
PO: Purusottam Pur
District: Mirzapur
State: Uttar Pradesh
PIN Code: 231305
Issue Date:03/08/2014
Signature Not Verified
Digitally signed by
Sandeep Bhardwaj
Date: 2024.11.12
17:45:33 IST
4823 5209 5816
Shubham Vishwakarma Address:
Download Date:12/11/2024
ज म तथ/DOB: 08-12-2004 C/O: Satish Kumar Vishwakarma,
Issue Date:03/08/2014
baghera, Baghera, PO: Purusottam Pur,
पु ष/ MALE
Dist: Mirzapur,
Uttar Pradesh, 231305
4823 5209 5816 4823 5209 5816
Signature Not
Verified
Signed by :SHUBHAM
VISHWAKARMA
Date : 12/11/2024 17:52:25
Reason : eSign Service
Location : India
