Acknowledgement for request for new PAN card (Form 49A)
ACKNOWLEDGEMENT NUMBER:
881020136022810
Citizen of India Y
Affix recent
photograph
(3.5cm x 2.5cm)
Category
Individual
Name
Shri DINESH SHIVRAM KSHIRSAGAR
Affix recent
photograph
(3.5cm x 2.5cm)
Name to be
DINESH SHIVRAM KSHIRSAGAR
printed on card
Father's Name Shri SHIVRAM KSHIRSAGAR
Date of Birth
Residential
Address
Signature/ Left Thumb
Impression across this
photo
09-11-1988
ROOM NO 12
DARBRI CHAWL
S PHULE CHAWL
DAHISAR WEST
MUMBAI - 400068
Maharashtra
Office Address
Address for
RESIDENTIAL
Communication
Telephone No.
91 9930534260
Email ID
KSHIRSAGARDINESH911@GMAIL.COM
AADHAAR No.
Payment Mode
Credit Card: Your Payment of ` 106 against transaction number 400-2574070 has been successfully processed.
I/We, Dinesh Kshirsagar the applicant, do hereby declare that what is stated above is true to the best of my/our information and belief.
The following documents are enclosed as:
Proof of Identity: Copy of Ration card having photograph of the applicant
Proof of Address: Copy of Bank account statement in the country of residence
Proof of Date of birth: Copy of Driving licence
Proof of Identity of representative assessee:
Proof of Address of representative assessee:
Any other document:
Date: 06-10-2015
Service Tax Code (Registration Number): AAACN2082NST001
Service Tax Registration Category: BUSINESS AUXILIARY SERVICES
CIN U72900MH1995PLC095642
(PLEASE READ INSTRUCTIONS GIVEN ON NEXT PAGE)
Signature/ Left Thumb Impression of Applicant
(inside the box without touching the sides and in BLACK INK ONLY)
Instructions:
1. The acknowledgement number above is your unique reference number for PAN application. Kindly quote this number for tracking
the status of your PAN application on https://tin-nsdl.com or any queries relating thereto.
2 Save and print this acknowledgement.
3. Application fee and mode of payment: Payment favouring 'NSDL-PAN' can be made as follows:
Sr. No.
Address for
Communication
Amount payable
( )
Indian
106
Credit card / Debit card/ Net Banking / Demand Draft (DD) payable at Mumbai.
Foreign
985
Credit card / Debit card / Demand Draft (DD) payable at Mumbai
Mode of payment
Please mention name of applicant and acknowledgement number on the reverse of DD.
4 Individual applicants affix your recent colour photograph (3.5 cm x 2.5 cm), sign the acknowledgement (inside the box provided
without touching the sides and in BLACK INK only) and enclose a Demand Draft (DD), if any, alongwith Proof of Identity, Proof
of Address and Proof of Date of Birth as specified in the application form.
5 Superscribe the envelope with 'APPLICATION FOR PAN - Acknowledgement Number' (e.g. 'APPLICATION FOR PAN 881010100000973').
6 Send the documents as specified in point no. 4 above to Income Tax PAN Services Unit, NSDL e-Governance Infrastructure
Limited, 5th floor, Mantri Sterling, Plot No. 341, Survey No. 997/8, Model Colony, Near Deep Bungalow Chowk, Pune 411016 Tel: 020-27218080; Fax: 020-27218081.
7 Your acknowledgement, Demand Draft if any, and proofs, should reach NSDL within 15 days from the date of online application.
8 Application will be processed only on receipt of relevant proofs and realisation of payment.
9 PAN card will be dispatched only to the communication address provided in your PAN application. Wherever the
Representative Assessee (RA) details ( item no.14 in Form 49A ) are mentioned in the application, PAN card will be dispatched to
the RA's address.
