N005165532 Signed
N005165532 Signed
N005165532 Signed
Application Number Bar Code Payment Reference: WDBS0876584944 Inward Number Bar Code
Payment Date: 2022-01-31 22:03:42.0 Rs.106.90/-
Application Source: UTIITSL WEB-SITE Application Date: 31/01/2022
User Id: INTERNET USER User Name: INTERNET USER
PAN CARD MODE : Both physical PAN and e-PAN Card Application Mode : Digital Application (e-KYC)
P T N W 2 1 1
eKYC-Application
✘
K U M A R
P A P P U
P A P P U K U M A R
1 0 0 2 1 9 9 9
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)
K U M A R
P I N T U
Mothers’s Name (optional except where mother is a single parent and PAN is applied by furnishing the name of mother only)
D E V I
A S H A
(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 : P I N T U R A Y K A R M O P U R
R A M D A U L I V A I S H A L I
B I H A R 8 4 4 5 0 3 I N D I A
✘
9 1 9 6 9 3 1 0 1 1 1 4
[email protected]
4 4 4 5 0 6 3 5 1 5 6 6
P A P P U K U M A R
✘
R A I
M U N N A
0
K A R M O P U R
Z A F R A B A D H
V A I S H A L I
B I H A R 8 4 4 5 0 3
AADHAAR Card issued by UIDAI (In AADHAAR Card issued by UIDAI (In Copy)
Copy)
AADHAAR Card issued by UIDAI (In Copy)
HAJIPUR
eKYC-Application
3 1 0 1 2 0 2 2
Enrolment No.: XXXX/XXXXX/XXXXX
To
Download Date:31/01/2022
Pappu Kumar
S/O: Pintu Ray
karmopur
Ramdauli
Vaishali Bihar-844503
Issue Date:18/03/2018
Vaishali,
पु ष/ MALE Bihar, 844503
Signature Not
Verified
Signed by :PAPPU KUMAR
Date : 31/01/2022 22:11:04
Reason : eSign Service
Location : India