U-Q019610719
5153105925560216 / PY0155508223
02/06/2025 10:59:01
D:316313160010
UserI Amount
: Rs.:106.90/- 02/06/2025
UserName: 316313160010 Appl
icat
i ce:EWALLET
onSour - A - CSC E GOVERNANCE SERV
dMode:Both physical PAN and e-PAN Card
PANCar Appl
icat
ionMode: Digital Application
B I H P R 8 7 5 9 R
✔
R A I
S A R A D A
S A R A D A R A I
✔
G U R U N G
G O M
B A H A D U R
✔ 2 7 1 2 1 9 7 6
✔ ✔
✔ ✔ ✔
M A N G L A B A R I P O J A I G A O N -
J A Y G A O N ( C T ) K A L C H I N I
J A L P A I G U R I
WEST BENGAL 7 3 6 1 8 2 INDIA
✔
9 1 9 7 7 5 4 4 4 0 9 8
jackmagar450@gmail.com
5 2 6 1 5 3 7 4 1 8 0 4
S A R A D A R A I
SARADA RAI HIMSELF/HERSELF
2
JAIGAON
0 2 0 6 2 0 2 5
Enrolment No.: XXXX/XXXXX/XXXXX
To
Download Date:02/06/2025
Sarada Rai
MANGLABARI
-
PO JAIGAON
VTC: Jaygaon (CT)
PO: Jaigaon
District: Jalpaiguri
State: West Bengal
PIN Code: 736182
Issue Date:24/08/2014
Signature Not Verified
Digitally signed by
Sandeep Bhardwaj
Date: 2025.06.02
11:06:41 IST
5261 5374 1804
Sarada Rai Address:
Download Date:02/06/2025
Date of Birth/DOB: 27-12-1976 MANGLABARI, PO JAIGAON, -, Jaygaon
Issue Date:24/08/2014
(CT), PO: Jaigaon, Dist: Jalpaiguri,
Female/ FEMALE
West Bengal, 736182
5261 5374 1804 5261 5374 1804
Consent Form Aadhaar holders
Biometric and/or OTP based eKYC and Aadhaar Authentication
PAN/ApplicationNo.:
Q019610719
Name as per PAN card:760255072247
SARADA RAI
Aadhaar number: xxxx-xxxx-1804
Name as per Aadhaarcard: SARADA RAI
Declaration:
I do hereby confirm that the Aadhaar given above has been issued to me by UIDAI. As a
part of process, the Aadhaar/eKYC data may be used only for the requirement of PAN
allotment.
I state that I do not have any objection in authenticating myself with Aadhaar based
authentication system and I hereby provide my consent to use my Aadhaar number,
Biometric and/or One Time Password (OTP) data for authentication for the purpose of
fulfilling the requirement under PAN process.
I understand that the Biometric and/or OTP provided for Aadhaar authentication /
eKYC data shall be used only for authenticating my identity through the Aadhaar
Authentication system for the purpose of only PAN allotment process.
This is further acknowledged that while submitting through Change Request Form in
PAN data. If in case, Aadhaar is not linked with PAN then through this process
Aadhaar will not be linked with PAN i.e. will be used for authentication /eKYC
purpose only.
I understand that complete security and confidentiality shall be ensured for my personal
identity data provided for the purpose of Aadhaar based authentication.
Date 02/06/2025 Signature / Thumb Impression
Signature Not
Verified
Signed by :SARADA RAI
Date : 02/06/2025 11:13:23
Reason : eSign Service
Location : India
