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Pan Card Correction Form

This document is a request form for individuals to apply for a new PAN card or make changes/corrections to their existing PAN data. It requests information such as name, father's name, date of birth, gender, address, phone number, email, and other PAN numbers held. The applicant must declare that the information provided is true and correct. They must also submit documents in support of any proposed changes along with their signature.

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lovingboy22
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135K views1 page

Pan Card Correction Form

This document is a request form for individuals to apply for a new PAN card or make changes/corrections to their existing PAN data. It requests information such as name, father's name, date of birth, gender, address, phone number, email, and other PAN numbers held. The applicant must declare that the information provided is true and correct. They must also submit documents in support of any proposed changes along with their signature.

Uploaded by

lovingboy22
Copyright
© Attribution Non-Commercial (BY-NC)
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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Request For New PAN Card Or/ And Changes Or Correction In PAN Data

Permanent Account Number (PAN)


Only 'Individuals'
to affix recent
photograph (3.5
cm x 2.5 cm)
Please read Instructions 'g' and 'h' for Red Coloured boxes on left margion of this form.

1 Name
Signature/ Left Thumb
Please Tick as applicable Shri Smt. Kumari M/s Impression
Last Name / Surname First Name

Middle Name

Name as you would like it printed on the Card


2 Father's Name (Only 'Individual' applicants : Even married women should give father's name only)
Last Name / Surname First Name

Middle Name

3 Date of Birth / Incorporation / Agreement / Partnership or Trust Deed / Formation


of Body of Individuals/ Associastions of Persons D D M M Y Y Y Y
4 Sex (for individual applicant only) Male Female

5 Photo Mismatch

6 Signature Mismatch

7 Address For Communication Please indicate if this is Residence or Office


Office Name (to be filled only in case of office address)

Flat/Door/Block No.

Name of Premises / Building / Village

Road / Street / Lane / Post Office

Area / Locality / Taluka / Sub - Division

Town / City / District State / Union Territory Pin

8 If you desire to update your other address also, give required details in additional sheet. (Indicating PIN is mandatory)
STD Code Tel. No.

9 Tel. No. email ID

10 Mention other Permanent Account Numbers (PANs) inadvertently allotted to you

PAN 1 PAN 3
PAN 2 PAN 4

I , the applicant, do hereby declare that what is stated above is

true to the best of my information and belief. I have enclosed (number of documents) in support of proposed changes/ corrections.

Verified today, the Signature/ Left Thumb Impression of


D D M M Y Y Y Y Applicant (inside the box)

Acknowledgment
Received with thanks from Shri/ Smt./ Kum./ M/s

CSF Number

PAN Number

PAN Service Centre Code

PAN Service Centre Name

Enclosures :
1

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