Form No. 49AA Application for Allotment of Permanent …

1 Form No. 49 AAApplication for Allotment of Permanent Account Number[Individuals not being a Citizen of india /Entities incorporated outside india /Unincorporated entities formed outside india ] See Rule 114To avoid mistake (s), please follow the accompanying instructions and examples before filling up the formAssessing officer (AO code)Area codeAO typeRange codeAO No. Sir, I/We hereby request that a Permanent account number be allotted to me/us. I/We give below necessary particulars: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 applicableShri/MrSmt/MrsKumari/MsM/sLast Name / SurnameFirst NameMiddle Name2 Abbreviations of the above name, as you would like it, to be printed on the PAN card3 Have you ever been known by any other name?

2 YesNo(Please tick as applicable) If yes, please give that other namePlease select title, as applicableShri/MrSmt/MrsKumari/Ms M/sLast Name / SurnameFirst NameMiddle Name4 Gender (for Individual applicants only)MaleFemale Transgender (Please tick as applicable)5 Date of Birth/Incorporation/Agreement/Partnershi p or Trust Deed/ Formation of Body of individuals or Association of PersonsDayMonthYear6 Details of Parents (applicable only for individual applicants)Father s Name (Mandatory. Even married women should fill in father s name only)Last Name / SurnameFirst NameMiddle NameMother s Name (optional)Last Name / SurnameFirst NameMiddle NameSelect 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 father s name)Father s nameMother s name(Please tick as applicable)

3 7 AddressResidence AddressFlat/Room/ Door / Block of Premises/ Building/ VillageRoad/Street/ Lane/Post OfficeArea / Locality / Taluka/ Sub- DivisionTown / City / DistrictState / Union TerritoryPincode / Zip code Country NameSignature / Left Thumb impressionOnly Individuals to affix recent photograph ( cm cm)Sign / Left Thumb impression across this photoOnly Individuals to affix recent photograph ( cm cm)Office AddressName of officeFlat/Room/ Door / Block of Premises/ Building/ VillageRoad/Street/ Lane/Post OfficeArea / Locality / Taluka/ Sub- DivisionTown / City / DistrictState / Union TerritoryPincode / Zip codeCountry Name8 Address for Communication ResidenceOffice(Please tick as applicable)

4 9 Telephone Number & Email ID detailsCountry codeArea / STD CodeTelephone / Mobile numberEmail ID10 Status of applicantPlease select status, as applicableGovernmentIndividualHindu undivided familyCompanyPartnership FirmAssociation of PersonsTrustsBody of IndividualsLocal AuthorityArtificial Juridical PersonsLimited Liability Partnership11 Registration Number (for company, firms, etc.)12 Country of citizenshipISD code of country of citizenship13 Source of IncomePlease select status, as applicableSalaryCapital GainsIncome from Business / ProfessionBusiness/Profession code[For Code: Refer instructions]Income from Other sourcesIncome from House propertyNo income14 Representative or Agent of the Applicant in india Full name, address of the Representative or AgentFull Name (Full expanded name.)

5 Initials are not permitted)Please select title, as applicableShri/MrSmt/MrsKumari/MsM/sLast Name / SurnameFirst NameMiddle NameAddressFlat/Room/ Door / Block of Premises/ Building/ VillageRoad/Street/ Lane/Post OfficeArea / Locality / Taluka/ Sub-DivisionTown / City / DistrictState / Union TerritoryPincode / Zip code15 Documents submitted as Proof of Identity(POI) and Proof of Address (POA)I/We have enclosed as proof of identity,asproof of address, andas mandatory certified documents [Please refer to the instructions (as specified in Rule 114 of Rules, 1962) for list of mandatory certified documents to be submitted as applicable]16 KYC details* [To be filled in by Foreign Institutional Investor or a Qualified Foreign Investor, as prescribed under the regulations issued by the Securities and Exchange Board of india (SEBI)] ["Control" as defined under SEBI (Substantial Acquisition of Shares and Takeovers) Regulations,1997 "Beneficial owner" as defined in the para of SEBI circular dated December 31, 2010 on Anti Money Laundering.]

6 ](a)In case of IndividualsPlease select as applicableMarital StatusSingleMarriedDivorcedWidow/Widower Citizenship StatusIForeignerPPerson of Indian originOOverseas citizen of IndiaIn case of foreigner, country of citizenshipOccupation detailsPrivate sector servicePublic sector/Govt. serviceBusinessProfessionalAgriculturist RetiredHousewifeStudentOthers(b)In case of non individualsPlease select as applicableRPrivate CompanyUPublic CompanyDBody CorporateSFinancial InstitutionNNon Government OrganizationCCharitable Organization(c)Gross Annual Income - INRN etworth (Assets less liabilities) in INR(d)In case of a Public Company, whether listed on a stock exchangeYesNoPlease select as applicableIf yes, then indicate name of the stock exchange(e)In case of Non-individualsDoes it have few persons or persons of the same family holding beneficial ownership and select as applicable[ Control.

7 Control shall include the right to appoint majority of the directors or to control the management or policy decisons exercisable by a person or persons acting individually or in concert, directly or indirectly, including by virtue of their shareholding or management rigths or shareholders agreements or voting agreements or in any other manner Beneficial owner means the natural person who ultimately owns or controls the applicant and/or the person on whose behalf a transaction is being conducted, and includes a person who exercises ultimate effective control over a juridical person](f)Is the entity involved / providing any of the following servicesPlease select as applicableForeign exchange, Money Changer ServicesYesNoGaming/Gambling/Lottery services (Casinos and Betting Syndicates)YesNoMoney Lending, PawningYesNo(g)Whether the applicant or the applicant s authorised signatories/trustees/office bearers is(i)a politically exposed personYesNo(ii)related to a politically exposed personYesNo[For definition of politically exposed person refer to guidelines issued under the Prevention of Money Laundering Act (PMLA)](h)

8 Taxpayer identification Number in the country of residence 17I/We, the applicant, in the capacity ofdo hereby declare that what is stated above is true to the best of my/our information and / Left Thumb Impression of Applicant (inside the box)DateINSTRUCTIONS FOR FILLING FORM 49AA(a) Form to be filled legibly in BLOCK LETTERS and preferably in BLACK INK. Form should be filled in English only(b) Each box, wherever provided, should contain only one character (alphabet /number / punctuation sign) leaving a blank box after each word.(c) Individual applicants should affix two recent colour photographs with white background (size cm x cm) in the space provided on the form.

9 The photographs should not be stapled or clipped to the form. The clarity of image on PAN card will depend on the quality and clarity of photograph affixed on the form.(d) Signature / Left hand thumb impression should be provided across the photo affixed on the left side of the form in such a manner that portion of signature/impression is on photo as well as on form.(e) Signature /Left hand thumb impression should be within the box provided on the right side of the form. The signature should not be on the photograph affixed on right side of the form. If there is any mark on this photograph such that it hinders the clear visibility of the face of the applicant, the Application will not be accepted.

10 (f) Thumb impression, if used, should be attested by a Notary Public or an authorized officer in respective country of residence under official seal and stamp.(g) AO code (Area Code, AO Type, Range Code and AO Number) of the Jurisdictional Assessing Officer must be filled up by the applicant. These details can be obtained from the Income Tax Office or PAN Centre or websites of PAN Service Providers on or (h) Guidelines for filling the Form 49 for filling the form1 Full NamePlease select appropriate not use abbreviations in the First and the Last example RAVIKANT should be written as :LastName/SurnameRAVIKANTF irst NameMiddle NameFor example SURESH SARDA should be written as :LastName/SurnameSARDAF irst NameSURESHM iddle NameFor example POONAM RAVI NARAYAN should be written as:LastName/SurnameNARAYANF irst NamePOONAMM iddle NameRAVIFor example SATYAM VENKAT M.