Application Number: U-N007940098

Application Number Bar Code Payment Reference: BHD1Q140UV1Z81 Inward Number Bar Code
Payment Date: 2025-08-31 18:58:19 Rs.71.90/-
Application Source: UTIITSL WEB-SITE Application Date: 31/08/2025
User Id: INTERNET USER User Name: INTERNET USER
PAN CARD MODE : e-PAN only, No Physical PAN Card Application Mode : Digital Application (e-KYC)

P T N W 2 7 1

eKYC-Application

✔
A S I F
M D

M D A S I F

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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)
A L A M
M D
R A Y E E S
Mothers’s Name (optional except where mother is a single parent and PAN is applied by furnishing the name of mother only)

(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 : M D R A Y E E S A L A M V I L L
D A R A P A T T I P O S T M A R W A N
J A I N K H U R D M A R W A N P A T A H I

M U Z A F F A R P U R

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 ✔

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Channeltasofficial@gmail.com

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M D A S I F

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

MD ASIF HIMSELF/HERSELF

MUZAFFARPUR
eKYC-Application

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 Enrolment No.: XXXX/XXXXX/XXXXX
To
Download Date:31/08/2025

Md Asif
S/O: Md Rayees Alam
Vill-Darapatti,post-Marwan
VTC: Jain Khurd
PO: Patahi
District: Muzaffarpur
State: Bihar
PIN Code: 843113
Issue Date:31/03/2015

Signature Not Verified

Digitally signed by
Sandeep Bhardwaj
Date: 2025.08.31
19:05:22 IST

5428 3607 7707

Md Asif Address:
Download Date:31/08/2025

ज म ￸त￱थ/DOB: 12-01-2007 S/O: Md Rayees Alam, Vill-Darapatti,post-

Issue Date:31/03/2015

Marwan, Jain Khurd, PO: Patahi, Dist:

पु ष/ MALE
Muzaffarpur,
Bihar, 843113

5428 3607 7707 5428 3607 7707

Signature Not
Verified
Signed by :MD ASIF
Date : 31/08/2025 19:10:50
Reason : eSign Service
Location : India