‘Since the application is digitally signed using eSign/eKYC, there is no need to forward physical documents: ‘Acknowledgemont Number: N-881191148144203 (1M | ll FormNO. 498 Application for Allotment of Permanent Account Number [inthe case of inaian Ctizensiindian CompaniesfEntities Incorporated In Inca! Unincorporated entities formed in ini] Under ection 1994 ofthe Income Tax act, 964 “Te sols mica 2, leave flow he secompanying Inswustons an exarpes bere ling up ‘Assessing officer (AO code) nn Si Let Thane meressor | (AREA CODE ‘AOTYPE | Range Code [ AONO acs ts poe LRN w 6 96 ‘Sir, We hereby request that a permanent account number be allotted to meus. Sarre RTS TT Iie gve below necessary particulars opcarteside eto 1. Full Name (Full expanded name to be mentioned as appearing In proof of document: initials are not permitted) Please select ttle, as applicable & sh ‘Smt. Kumari) wis Last NameiSumame First Name ‘SHOBHIT Midcte Name haa i TSA (soon gour Ska a aT tyes, please give that other name. Ol ves No Please select title, as applicable O sm O sm OF Kumi OO ms Texncnomuene ane ate 4. Gender(for individual applicants only) ‘Male Ti Femaie Transgender 1a ot Deena Te ia Pon BS of ai 6 eos ef PS SS 6. Details of Parents (applicable only for individual applicants). Whether mother isa single parent and you wish to apply for PAN by furnishing the name of your mother only? Yes O Nol (please tick as applicable) It yes,please ln mother's name in the eppropriate space provided below. Fathera€"™s Name (Mandatory except where mother i a single parent and PAN Is applied by furnishing the name of mater only Last NameiSumame /SAWARE FirstName RAM la Name "Mother's Name (Optional except where mother ie a single parent and PAN is applied by furnishing the name of mother only) Last Name/Surname DEVT rt Name SANIT Midate Name ‘Select the name of eter tater or meer which you may Ie Tobe pried on PAN card (Selec one oni) {hv cas0 no options prowded then PAN aca wil be sued wi atharae™s name) %_Fainors Namo Moers name (Prease uekas appicabi) {tn case no option is provided then PAN card will Bissued with father's name except where mother is single parent and you wish to apply for PAN by fursishing name of mother only) 7. Address Residence Address Flat/ Room /Daot | Black Na Name of Premises Bulding | Vilage, LOURIHAWA [UTTAR PRADESH Bra00F INDIA 1 — Name ot once Post Flat Room / aot | Black Na Namo of Premises / Bulding Vilage PLOURHAWA oad /Stoct/LanePost Orica [INDIAPOST ‘Area / Locality Taluka! Sub- Dvision [BAST SADARTorn 03 Sit UronTetony Pode 2p code outy Na (rar erabesn aa001 ROA ] [Address for Communication TE Residence ome: Please tick as applicable 8. Telephone Number & Emall 0 detalls couse eat cae Tegner Co) mer ee ‘Prease select status, 1/% as applicable TO Sovemment Bl indviouel sind undvie fomiy «Company 1D reesei T association ot Prsons DD Trusts 1D body otineivitats Ty Local Authority Ef acti! turical Persons] LinitedLitiy Parinership 14, Roglatration Number (for company, fre, LLP ets) 412, Incase of a person, who is required to quote Aadhaar number of Aadhaar application form as per section 138AA Please mention your AADHAAR number (if allotted) ooooanxss7s Name as per AADHAAR letarcard of Aachaar aplication TCaRIT 12. Sours oficome TF saery Busness Pretesion For Code Relerinstuctons| o> cael Gare i incare om Business seca nom omer sours TB cre tom House prey TF to ncame 14, Representative Assessee (RA) Ful name, address of ne Representatve Assess09, who is assossbio undor the income Tax Acn respect of the parson, wnese parculars have been given inthe column 1-13, Full Name (Full expancied name int Pease slectie as ampteabe osm Of koma os Lest Name'Sumame ( Fest Name dale Nam esses Name of Premises Buling Road Steet Lana/Post Office ‘Area / Localiy / Taluka! Sub- Division oun! City) Distct, State / Union Teton Pinca County Name 45, Documents submited ae Proof of identity (POH, Proof of Address (POA) and Proof of Date of Birth (O08) lo nave encosea [ AADWAAR Card issued by the Unique identiation Authority of Inala agit iy "RADHAAR Card issued by the Unigue Identification Authority of Inala [as proof of across and (AADHAAR Card Issued by the Unique Identfcaion Authority of India proc i ike si [Proase refer foto stuns (as spociiod in Rulo 174 O77. Rios, 7062) Tor It of mandalovy coruied documents tobe Suid as appicable [Annexure A, Arnanure 8 & Anaanure Care to be used wherever applicable 10 (We [=eToar J ne alean, nt eapacty of [Himselferaelt ‘0 heceby dear that wha stad above sve 1 the best of your imation and Dotet, Place BAST Doan ate Ber Snare LH SST