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Pan Form

The document is an application for a PAN card submitted by Lokesh Kumar Jat through the UTIITSL website, with a payment of Rs.106.90 made on April 29, 2025. It includes personal details such as the applicant's name, date of birth, and address, along with options regarding parental information. The application was completed digitally using e-KYC and includes a digitally signed verification.

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govindsingh000095
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9 views3 pages

Pan Form

The document is an application for a PAN card submitted by Lokesh Kumar Jat through the UTIITSL website, with a payment of Rs.106.90 made on April 29, 2025. It includes personal details such as the applicant's name, date of birth, and address, along with options regarding parental information. The application was completed digitally using e-KYC and includes a digitally signed verification.

Uploaded by

govindsingh000095
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Application Number: U-N007609976

Application Number Bar Code Payment Reference: BHD1YY80JI1UDQ Inward Number Bar Code
Payment Date: 2025-04-29 10:45:38 Rs.106.90/-
Application Source: UTIITSL WEB-SITE Application Date: 29/04/2025
User Id: INTERNET USER User Name: INTERNET USER
PAN CARD MODE : Both physical PAN and e-PAN Card Application Mode : Digital Application (e-KYC)

R J N C 1 0 1 1

eKYC-Application

✔
J A T
L O K E S H
K U M A R

L O K E S H K U M A R J A T

1 8 0 4 2 0 0 3

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)
J A T
S U N I L A L

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 R J O

(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) ✔

S / O S U N I L A L J A T W A R D N O
1 1 D H A N I J O D A L A K A N T
S H A H P U R A K A N T S H A H P U R A

K A N T J A I P U R

R A J A S T H A N 3 0 3 1 0 3 I N D I A
✔

9 1 0 1 4 2 2 9 6 9 4 9 1 2 8 4 4
Lokeshjat2844@gmail.com

7 7 9 3 3 5 0 6 4 9 1 1

N O T A P P L I C A B L E W E F 0 1 1 0 2 0 2 4

L O K E S H K U M A R J A T

AADHAAR Card issued by AADHAAR Card issued by UIDAI


UIDAI (In Copy) (In Copy)
AADHAAR Card issued by UIDAI
(In Copy)

LOKESH KUMAR JAT HIMSELF/HERSELF

SHAHPURA
eKYC-Application

2 9 0 4 2 0 2 5
Enrolment No.: XXXX/XXXXX/XXXXX
To
Download Date:29/04/2025

Lokesh Kumar Jat


S/O Suni Lal Jat
ward no 11
dhani-jodala
kant Shahpura
VTC: Kant
PO: Kant
District: Jaipur
State: Rajasthan
PIN Code: 303103
Issue Date:12/12/2012

Signature Not Verified


Digitally signed by
Sandeep Bhardwaj
Date: 2025.04.29
10:46:00 IST

7793 3506 4911

Lokesh Kumar Jat Address:


Download Date:29/04/2025

ज म ￸त￱थ/DOB: 18-04-2003 S/O Suni Lal Jat, ward no 11, dhani-


Issue Date:12/12/2012

jodala, kant Shahpura, Kant, PO: Kant,


पु ष/ MALE
Dist: Jaipur,
Rajasthan, 303103

7793 3506 4911 7793 3506 4911

Signature Not
Verified
Signed by :LOKESH KUMAR JAT
Date : 29/04/2025 10:51:54
Reason : eSign Service
Location : India

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