U-Q017228127

4346193529293361 / PY0145207136
11/12/2024 19:35:19
D:351271640018
UserI Amount
: Rs.:106.90/- 11/12/2024
UserName: 351271640018 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

H C D P S 0 9 6 9 G

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S H Y O J I

S H Y O J I

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M A N G I L A L

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S / O M A N G I L A L 7 B H I L O N K A
M O H A L L A T A K H O L I T O N K
T A K H O L I

T O N K

RAJASTHAN 3 0 4 0 0 1 INDIA

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boxmail595@gmail.com
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S H Y O J I
SHYOJI HIMSELF/HERSELF

4
KOTA

1 1 1 2 2 0 2 4
 Enrolment No.: XXXX/XXXXX/XXXXX
To
Download Date:11/12/2024

Shyoji
S/o MANGILAL
7 BHILON KA MOHALLA
TAKHOLI
TONK
VTC: Takholi
PO: Takholi
District: Tonk
State: Rajasthan
PIN Code: 304001
Issue Date:30/11/2011

Signature Not Verified

Digitally signed by
Sandeep Bhardwaj
Date: 2024.12.11
19:48:57 IST

5515 5650 4410

Shyoji Address:
Download Date:11/12/2024

ज म ￸त￱थ/DOB: 01-01-1966 S/o MANGILAL, 7 BHILON KA

Issue Date:30/11/2011

MOHALLA, TAKHOLI, TONK, Takholi,

पु ष/ MALE
PO: Takholi, Dist: Tonk,
Rajasthan, 304001

5515 5650 4410 5515 5650 4410

 Consent Form Aadhaar holders

Biometric and/or OTP based eKYC and Aadhaar Authentication

PAN/ApplicationNo.:
Q017228127

Name as per PAN card:760255072247

SHYOJI

Aadhaar number: xxxx-xxxx-4410

Name as per Aadhaarcard: SHYOJI

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 11/12/2024 Signature / Thumb Impression

Signature Not
Verified
Signed by :SHYOJI
Date : 11/12/2024 19:58:53
Reason : eSign Service
Location : India