Assessing Officer (AO Code)
Assessing Officer (AO Code)
Assessing Officer (AO Code)
RJN W 570 5
Sir, I/We hereby request that a permanent account number be allotted to me/us.
Signature / Left Thumb Impression of
I/We give below necessary particulars: Applicant (inside the box)
1. Full Name (Full expanded name to be mentioned as appearing in proof of identity/address documents: initials are not permitted)
Please select title, as applicable Shri Smt Kumari M/S
Last Name/Surname LAL
First Name
PANCHAI
Middle Name
2. Abbreviations of the above name, as you would like it, to be printed on the PAN card
PANCHAI LAL
3. Have you ever been known by other name?
If yes, please give that other name Yes No
Please select title, as applicable Shri Smt. Kumari M/S
Last Name/Surname
First Name
Middle Name
First Name
Middle Name
Select the name of either father or mother which you may like to be printed on PAN card (select one only)
(In case no option is provided then PAN card will be issued with fathers name)
Father's Name Mother's Name (Please tick as applicable)
7. Address
Residence Address
Flat / Room / Door / Block WARD03
91 9929628567
Email ID [email protected]
10. Status of applicant
Please select status, as applicable Government
Trusts Body of Individuals Local Authority Artificial Juridical Persons Limited Liability Partnership
11. Registration Number (for company, firms, LLPs etc.)
945127742445
13. Source of Income
Salary Capital Gains
Income from Business / Business/Profession [For Code: Refer instructions] Income from Other sources
Last Name/Surname
First Name
Middle Name
Address
Flat / Room / Door / Block
15. Documents submitted as Proof of Identity (POI), Proof of Address (POA) and Proof of Date of Birth (DOB)
I/We have enclosed AADHAAR Card issued by the Unique as proof of identity AADHAAR Card issued by the Unique Identification
as proof of address and AADHAAR Card issued by the Unique Identification Authority of India as proof of date of birth.
[Please refer to the instructions (as specified in Rule 114 of I.T. Rules, 1962) for list of mandatory certified documents to be submitted as
applicable
[Annexure A, Annexure B & Annexure C are to be used wherever applicable]
16 I/We PANCHAI LAL the applicant, in the capacity of Himself/Herself
do hereby declare that what is stated above is true to the best of my/our information and
belief.
Place PANCHOO
DD MM YYYY
Date 21/02/2017
Signature / Left Thumb Impression of
Applicant (inside the box)