A i 4106/2025 Rs.107.00/- [Application Source: [EWALLET -A- CSC E GOVERNANCE SERVICES INDIA LIMITED Application Date 14/05/20: lUser ts [242347770010 ]ser Name-[242347770070 [PAN CARD MODE - Both physical PAN and e-PAN Card Applicat Form No. 408, ion for Allotment of Permanent Account Number Unincorporated entities formed in india ‘So ue 14 ng officer (AO cade) ‘rea code ‘AO type [Range code 6 w ‘Sic ie nary request that a ermanent Account umber be alte to mol, Ie ge below necessary partcare Full Nome (Full expanded name to be mentioned a a ication Mode = Physical Appi {in the case of indian Ctizons! Indian Companies! Enties incorporated in Ini Pease sect te,[//]asappatie [| sit Last Name / Surname JIATHI I nae wot cc Hare is inhsas ag a a MD) Wala 'TR[ujo/o iNT | H T Telalab sya pst t f I im | Have you ever been known by any othername? — [_] Yes Y¥] No [please tick as applicable) Pease siete, [Vas apical [] sit Jo [Jeon [Te Last Name / Sumame LI I ert) i) | | Et eathied I i fasted hake Mele Name OTT 1 | sal [ie een ew! Gender (for individual applicants only) v¥ | Mate (please tick as applicable), Date of Birth/incorporation/Agreement/Partnership or Trust Deed! we Formation af Body of individuals of association of Porsor 2/0|o/ 6] Soe arnea iteomey he homaincieaet \neter mother sa sngle parent anc you veh io apy for PAN by Kuishng the name of your mother on? Yes[] No[ 7] (lease Sk as appicab Peper ee [lnclegelalfieticllseispesl i em) poe ES ‘Last Name / Sumame [HJA QUE J i 1 Fiat Name [ef vials|u[D|o/ TIN foe 1 ‘ase Elta Ertl Mane Pel ep ten Se Sa ee rear aoe Last Name / Sumame I tt First Name 1 ares ett eect Sal rar lol ier rae it Yr na Ts bs BES GAT Bre pt pret er co oe rc pd you cy PAN by fumshing name ofthe metherony) [7] ranersname [_]Mother's Name cranes. tty Asdrors Fesidence Address Fat Room / Dec Block No, Name of remiss / usin / Vilage Rood / Sree Lane!Post Ole ‘Awa! Locality! Talal Sub- Don Tow | iy /Diser State / rion Terry WEST Office Address Name of tice ‘BENGAL RIA Flt Room /Doot/ Block No i= Name of Premises / Bung Vilage Road / Set | Lane/Post Of‘Ara / Local Taluka! Sub- Dion Town | Cy /Distict 8 Address for Communication [7] Residence Jomce (Please ok as appcabe) 9. Talhone Number 8 Ema IO detais ia Comtycate—_Ara/STO Code THlephne / Moble number sf. | [ 7[o[2|s[3[@[2|e[2]7 emai [m-sGiniemet@gmailcom 10 Stats of appicant Poss sean, 7] saps eos eee Ol ee pee Cre Emoyernenne — ]laataaty) [eters ined ety Pt 1 Rghatraton Number or company, rms, LLPS ete) | : : I I Jot 12 Case of person, who is equred to quote Aadhaar number/The Enrolment 0 ot Aadhaar application form as per secon {304A Paase monton your MDHAAR number (t atated) [40] 6] 4] [5]4] 0] 3] [6] 7] 3] 7 |AADHAAR number isnot alloted, please mention the enroimont ID of Aadhsar aplleation form N[O[T]_JAPPICL TCyAT BLE [WEF] [9] 4] Wo] 2] 0] 2] 4] | Nam as per AADHAAR lator os porte Enrimen 1D of Aachaar eppiation form MO] _[J/ATH 1 [RI U[D] Oy IN) I ] I asd I T 13. Source of Income C1 setery D7 hrcome rom House property 1 hoincome income rom Business / Profession 14 Representative Assessee (RA) Ful name, adress ofthe Representative Assessoe, whois assessible been given nthe column 1-13, Full Name (Full expanded name inital are not permitted) Businessirotessioncooe |_|] For Code: Rete instructions) ‘under the Income Tax Actin respect of he person, whose particulars have Please select me, [7 ]as apptcabie san json. Vv} Last Name / Sumame First Name Midate Name Address Flat loom / Door / Block No ‘Name of Premises / Building / Vilage Road / Seet Lane Post Ofice ‘Area / Local Taluka’ Sub- Onision Town | Cty /Distrct ‘State / Union Tetory Pincode 18 Documents submitted as Proof of ldentity (PON, Proof of Address (POA) and Proof of Date of Birth (O08) We have enclosed | AADHAAR Card 18860 BY | 9s prot of ionty, (MADHAAR Card Issued by UIDAT | ‘as proof of address and PAADHAAR Card issued by UIDAT |} as proot of date of bith [Please reler to the instructons (a8 specified in Rul 114 of 17. Rules, (Annexure A, Annexure 8 40, Wee (MO SREIRUOOIN aaa Annexure C ae tobe used wherever applica) ‘the applicant, in the capacity of SEL el ‘SEU Ge 1962) for Sst of mandatory ceri documents to be submited as applicable) ‘doereby decare that whats stated above is true othe best of mylour information and bale. Pisce: (JOGHAR DomMMyYyyyy Date 2[4Jo[6[2[o]2]5 md hivudtin ‘Signature / Lett Thumb Impression of_ Applicant (inside the bow)md dolinunddin 0293719 29-