Transcription of Request For New PAN Card Or/ And Changes Or …
1 Request For New PAN card Or/ And Changes Or Correction in PAN DataPermanent account number (PAN)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 applicableShriSmtKumariM/sLast Name / SurnameFirst NameMiddle NameName you would like it printed on the PAN card2 Father's Name (Only 'Individual' applicants: Even married women should fill in father's name only)Last Name / SurnameFirst NameMiddle Name3 Date of Birth/Incorporation/Agreement/Partnershi p/Trust Deed/ Formation of Body of individuals or Association of Persons 4 Gender (for 'Individual' applicant only)MaleFemale(Please tick as applicable)5 Photo Mismatch6 Signature Mismatch7 Address for Communication ResidenceOffice(Please tick as applicable)Name of office (to be filled only in case of office address)Flat/Room/ Door / Block No.
2 Name of Premises/ Building/ VillageRoad/Street/ Lane/Post OfficeArea / Locality / Taluka/ Sub- DivisionTown / City / DistrictState / Union TerritoryPincode / Zip codeCountry Name8 If you desire to update your other address also, give required details In additional Telephone number & Email ID details Country code Area/STD CodeTelephone / Mobile numberEmail ID10 AADHAAR number (if allotted)11 Mention other permanent account Numbers (PANs) inadvertently allotted to youPAN 1 PAN 3 PAN 2 PAN 412 VerificationI/We, the applicant, in the capacity ofI/We have enclosed ( number of documents) in support of proposed Changes /corrections.
3 PlaceD D M M Y Y Y YDatePlease read Instructions 'h' & 'i' for selecting boxes on left margin of this / Left Thumb Impression of Applicant (inside the box)do hereby declare that what is stated above is true to the best of my/our information and belief. DayMonthYearSignature/ Left thumb impression across this photo
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