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    K002301873 Signed

    Uploaded by

    arjunbordoloi1005

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    K002301873 Signed

    Uploaded by

    arjunbordoloi1005
    11 views4 pages

    Original Title

    K002301873_SIGNED

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    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    11 views4 pages

    K002301873 Signed

    Uploaded by

    arjunbordoloi1005

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    U-K002301873

    PY0010395808
    24/03/2024 17:43:31
    D:PANM-PA7086950145 Amount
    UserI : Rs.:106.90/- 24/03/2024
    UserName: PANM-PA7086950145 Appl
    icat
    i ce:PSA
    onSour - ETN - PAN MITRA
    dMode:Both physical PAN and e-PAN Card
    PANCar Appl
    icat
    ionMode: Digital Application

    D W I P D 6 3 1 9 C

    ✘
    ✔
    D A S
    S U C H E N

    S U C H E N D A S

    D A S
    M A L A R A M

    0 1 0 1 1 9 7 2
    ✔ ✔
    ✔ ✔ ✔

    C / O : M A L A R A M D A S
    K H O L A G A O N M A Y O N G

    M A R I G A O N

    ASSAM 7 8 2 4 1 1 INDIA

    9 1 6 9 0 0 9 6 1 8 8 0
    [email protected]
    ✔ 4 5 9 1 2 3 2 0 5 2 5 3
    S U C H E N D A S

    DW I P D 6 3 1 9 C
    SUCHEN DAS HIMSELF/HERSELF

    3
    TIKHABORI

    2 4 0 3 2 0 2 4
    Enrolment No.: XXXX/XXXXX/XXXXX
    Download Date:24/03/2024

    To
    Suchen Das
    C/O: Malaram Das
    VTC: Kholagaon
    PO: Khulagaon
    District: Marigaon
    State: Assam
    PIN Code: 782411
    Issue Date:12/01/2021

    Signature Not Verified


    Digitally signed by DS
    UNIQUE IDENTIFICATION
    AUTHORITY OF INDIA 04
    Date: 2024.03.24 17:45:34
    IST

    4591 2320 5253


    Download Date:24/03/2024

    Suchen Das Address:


    Issue Date:12/01/2021

    Date of Birth/DOB: 01-01-1972 C/O: Malaram Das, Kholagaon, PO:


    Khulagaon, Dist: Marigaon,
    Male/ MALE Assam, 782411

    4591 2320 5253 4591 2320 5253


    Consent Form Aadhaar holders

    Biometric and/or OTP based eKYC and Aadhaar Authentication

    PAN/ApplicationNo.:
    K002301873

    Name as per PAN card:760255072247


    SUCHEN DAS

    Aadhaar number: xxxx-xxxx-5253

    Name as per Aadhaarcard: SUCHEN DAS

    Declaration:

    I do hereby confirm that the Aadhaar given above has been issued to me by UIDAI. As a
    part of process, the Aadhaar/eKYC data may be used only for the requirement of PAN
    allotment.

    I state that I do not have any objection in authenticating myself with Aadhaar based
    authentication system and I hereby provide my consent to use my Aadhaar number,
    Biometric and/or One Time Password (OTP) data for authentication for the purpose of
    fulfilling the requirement under PAN process.

    I understand that the Biometric and/or OTP provided for Aadhaar authentication /
    eKYC data shall be used only for authenticating my identity through the Aadhaar
    Authentication system for the purpose of only PAN allotment process.

    This is further acknowledged that while submitting through Change Request Form in
    PAN data. If in case, Aadhaar is not linked with PAN then through this process
    Aadhaar will not be linked with PAN i.e. will be used for authentication /eKYC
    purpose only.

    I understand that complete security and confidentiality shall be ensured for my personal
    identity data provided for the purpose of Aadhaar based authentication.

    Date 24/03/2024 Signature / Thumb Impression

    Signature Not
    Verified
    Signed by :SUCHEN DAS
    Date : 24/03/2024 17:54:00
    Reason : eSign Service
    Location : India

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