यहा पर कस्टमर के

Request For New PAN Card Or/ And Changes Or Correction in PAN Data

दोनों फोटो लगाए

Only ‘Individuals’ to affix Only ‘Individuals’ to affix

यहा पर पेन नंबर

recent photograph recent photograph
(3.5 cm × 2.5 cm) Permanent Account Number (PAN) (3.5 cm × 2.5 cm)

ललखे
Please read Instructions ‘h’ & ‘i’ for selecting boxes on left margin of this form.

Signature / Left thumb

impression across this photo कस्टमर के signature बॉक्स के अंदर
कराने हैin proof of identity/address
1 Full Name (Full expanded name to be mentioned as appearing
documents: initials are not permitted)

Please select title, 🗸 as applicable Shri Smt Kumari M/s

Signature / Left thumb impression
Last Name / Surname

यहा पर कस्टमर का नाम

First Name
Middle Name
Name you would like it printed on the PAN card
फफल करना है ओर अगर
नाम लसंगल नाम का है
2 Details of Parents (applicable only for Individual applicants) तो वह last name वाले
कॉलम मे फफल होगा
Father’s Name (Mandatory. Even married women should fill in father’s name only)
Last Name / Surname
First Name
Middle Name

यहा पर कस्टमर के
Mother’s Name (optional)
Last Name / Surname
First Name
फादर का नाम फफल करे
Middle Name
Select the name of either father or mother which you may like to be printed on PAN card (Select one only)
(In case no option is provided then PAN card will be issued with father’s name) Father’s Name Mother’s Name (Please tick as applicable)

यहा पर कस्टमर की date of birth

3 Date of Birth/Incorporation/Agreement/Partnership/Trust Deed/ Formation of Body of individuals or Association of Persons

फफल करे
Day Month Year

4 Gender (for ‘Individual’ applicant only) Male Female Transgender (Please tick as applicable)
5 Photo Mismatch
6 Signature Mismatch
7 Address for Communication Residence Office यहा पर वो adress
(Please tick as applicable)

फफल करना है जो
Name of Office (to be filled only in case of office address)
Flat/Room/ Door / Block No.
Name of Premises/ Building/Village कस्टमर के आधार
कार्ड मे है
Road/Street/ Lane/Post Office
Area / Locality / Taluka / Sub- Division
Town / City / District
State / Union Territory Pincode / Zip code Country Name

8 If you desire to update your other address also, give required details In additional sheet.
9 Telephone Number & Email ID details यहा पर mobile no
Country code Area/STD Code Telephone / Mobile number ओर mail id ओर
aadhar no फफल करे
Email ID
10 AADHAAR number (if allotted)
Name as per AADHAAR letter/card
यहा पर कस्टमर का नाम फफल करे यहा पर कस्टमर के
यहा पर himself या herself फफल करे signature कराए
11Mention other Permanent Account Numbers (PANs) inadvertently allotted to you
PAN 1 PAN 2 PAN 3 PAN 4
12 Verification
I/We , the applicant, in the capacity of do hereby
declare that what is stated above is true to the best of my/our information and belief.
I/We have enclosed (number of documents) in support of proposed changes / corrections.
Place
D D M M Y Y Y Y
Date Signature / Left Thumb Impression of
Applicant (inside the box)
Note: As per provisions of Section 272B of the Income Tax Act., 1961, a penalty of ` 10,000 can be levied on possession of more than one PAN.