Tax Invoice Cum Acknowledgement Receipt of PAN Application (Form 49A)
Tax Invoice Cum Acknowledgement Receipt of PAN Application (Form 49A)
Tax Invoice Cum Acknowledgement Receipt of PAN Application (Form 49A)
Proof of Identity AADHAAR Card issued by the Unique Identification Authority of India
Proof of Address AADHAAR Card issued by the Unique Identification Authority of India
Proof of DOB AADHAAR Card issued by the Unique Identification Authority of India
This is a computer generated receipt and does not require signature. Online PAAM 1.2
Applicant's Copy
Tax Invoice cum Acknowledgement receipt of PAN Application (Form 49A)
Tax Invoice cum N - 232799701982433 Date- 10 Feb 2021
Acknowledgement
Proof of Identity AADHAAR Card issued by the Unique Identification Authority of India
Proof of Address AADHAAR Card issued by the Unique Identification Authority of India
Proof of DOB AADHAAR Card issued by the Unique Identification Authority of India
On behalf of NSDL e-Governance Infrastructure Limited (PAN-Centre Managed by NSDL)
PAN application fee `91.00
Branch ID: 23279 Integrated Data Management Services Private Limited
C/O. I - NET SECURE LABS PVT.LTD 1045/527, GANTEC BUILDING, 2ND F ARUMBAKKAM CHENNAI TAMIL NADU 600106 CGST 9% `0.00
SGST 9% `0.00
IGST 18% `16.38
Note:- “As per instruction from Income Tax Department, an authorized agencies’ agent may visit you for your identity and address
verification as per the documents submitted by you with the PAN application form. You are requested to ask authorization letter/ID
card from the agent before verification. Your cooperation is solicited in this regard.” Total(Rounded Off) `107.00
GSTIN:27AAACN2082N1Z8 CIN: U72900MH1995PLC095642 SAC : 998319
For queries and information please contact: PAN/TDS Call Centers
020 - 27218080 020 - 27218081 [email protected] @NSDLeGovernance
Income Tax PAN Services Unit (Managed by NSDL)
5th floor, Mantri Sterling, Plot No. 341, Survey No. 997/8, Model Colony, Near Deep Bungalow Chowk, Pune – 411 016
If mobile no. is mentioned then you will receive SMS on status of your application.
You may track the status of your application using SMS facility – Type NSDLPAN<space>15 digit acknowledgement no. and send it to 57575 or by visiting our
website www.tin-nsdl.com.
You are also requested to provide feedback on your experience of PAN service at www.cleanmoney.gov.in
This is a computer generated receipt and does not require signature.
Online PAAM 1.2
Form No. 49A
Applicalion for Allotment ot Pennanent Account Number
Un th6 case oflndian cilizensrlndian Companies/Entities incorporated in lndia/
tlnincorpotated eBtitiet form€d in lndial
Sss Rule t1lt
-ro
ahid mBiake 13), pl.e foll lhe a@omp6nyng insrudron6 8nd eramd6 betoB filling !p th6 aom
c ll E 3 ! I
hereby requestthat a permanent accol/nt number be allotted to me/us V.e. QJd4f/, Qu^^,\'e-
signalure / Len Thumb lmpression
l/vve give below nocessary partlculars:
\t+' ,l Full Name (Full expanded name to be mentioned as appearing in proof of identity/date of birlh/eddress docuftents: inilials are nol permitted)
First Name at A, 14 N t) l1 R U
I
I
2 Abb.eviations ot the above name, a! you would lik6 it, to be printed on the PAN catd
q 1' T '11 T +l ) U K :f v A p,
fr
Please select tille, as applicable Shri Sml. Kumari
E
Last Name / Sumame f II
First Name ll I
Middle Name
,l Gender (for lndividual applicants only) pl r,r"r' Female Tlansg6ndet (please tick as applicable)
First Name
Middle Name
Solect the name of either father or molher which you may like to be printod on PAN card (Se/eci ore orl,
ffi Frth"r'" n"r" Mother's name
(Please tick as applicable)
(ln case no option is provided then PAN card will be issued with fathefs name except where mother is a single parent and you wish to apply for PAN
by fumishing name oftho motheronly)'
7 Addre6s
Resldence Address
Flat / Room / Door / Block No. t CN
IIIIIII
8
9
Addrssa for Communication
Telephone Number & Email lD details
V Residence Office (Pleass tlck as applicable)
Email lD
+ a tl IIIII llq
Sui'rnrnrnohon .!oo& /D 9ne,,ir.
I l- l -7 q
c-c, m
l i 1
l0 Status ofapplicant
Please select status,
Z as applicable Government
lD
I |llll
ofAadhaa. application form as per section 139 AA
Please mention yoUTAADHAAR numbor (if allotted) q I1 x o 3 I I D Z )
IfAADHAAR number is not allotted, please mention the enrolment lD ofAadhaar a ication form
II Salary
lncome from Business / Profession Business/Profession code [For Code: Refer instructions]
Capital Gains
lncome from Other sources
Full name, address of the Representative Assessee, who is assessible under the Income Tax Act in respect of the person, whose particulars have
been given in the column '1-13.
Full Name (Full expanded name : Initial8 are not pemitled)
Please select title,
Last Name / Sumame
as applicable Shri
IIIIIII
Smt.
-l Kumari
First Name
[Iiddle Name
fT_T_T_rT_r
ITIIIIIIIIIIIT IIIT
Address
Flat / Room / Door / Block No.
Name of Premises / Building / Village
IIII]EI
IIIIIIIIIIIIII It] I=T t-
Road / Street / Lane/Post Office
TIIIIIIIIIIIII
ITIITI
Area / Locality / Taluka/ Sub- Division
TownlCity/District
IITTITITITI
IIIIIIIIIIIIII
State / Union Territory Pincode
15 Documents submltted as Proof of ldentity (POl), Proof ofAddress (POA) and Proof of Date of Blrth (POB)
l/We have enclosed AAT) }+A a as proof of identity, I RR:D HCR
as proof of address and AEDHTT? as proof of date of birth
lPlease refer to the inst uctions (as specified in Rule '114 of l.T. Rules, 1962) for list of mandatory certified documents to be submitted as applicablel
[Annexure A, Annexure B & Annexure C are to be used wherever applicable]
16 l/vve , the applicant, in the capacity of utM.qtr )--F
do hereby declare thai whal is stated a is kue to lhe best of my/our iniormalion and belief.
Place :
V.R fu-rr-iftv Gw'Lr.
D DM M Y YY Y Signature / Left Thumb lmpression of
Date bq o s t Applicant (inside the box)
ffi*
$.\ aflkl t{{+tt A'
'SITIITT
Unique ldentification Authonty of lndia
Govemment of lndia
a E E@