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Form No. 4 Application or Aloient of Penmanent Account Number [ie the case of Indian Gitzena/indlan Companis/Eatises imccrporste ty India! ‘Unincorporated enitios formed i India) “See ‘Wnt i shee te my ta i tn i __ Assessing officer 120 cod} ‘Ares code E ‘AO tyes | Range code ‘AON. | : ftp re a We a BA AES (ive hereby requesthet x pemanen’aceourr numer be slated to mats. Ive ove alow necaneary partes: Saree \4 Full Name Full epended name to ba mentioned as appearing in proot ot anttyMate of bithedérass documents: initials are not permitted) im appcace (Jon Jent ]himon [Jie Lat Nama / Sums Bio RIO lear el First Narme SOON Mie Nave E 2 eran aye i pi he EERE Ee 3 Haveyoumer bom lnown byanystername?— [_]¥e pile Mp leone gv a ce re I Pave adeatttie [7] appticatte [Js js Jruman Yt (a Name /Sumame T ear ‘kde Name “4 Cmdr Hor nail spphicants onty) [ate [| Femate |] Tranagender _(pouso Sch as applicable) 5 Daten oy ton PL) GIO fess j (5 Detale of Parent (apple oly fr ini pcan) aR. Fibers Name (anda. Even maried veren shou fl afar nan ot) Lanter Frttane ete ane Mother's Name fortionat) Lutron 4 Fane eae ist teens ont aps a ame remern ae cllt Ucce ts ae 4 fenarename —[]ibers rae (bao apa) eo Saree ee etimane Nearest hac, ent ceccns Floats aleve x asa ABSA, [Tanai Narre ofc Fat Room Boor /Beck No. Nome ef Premiges/Buldng tage ‘oad / Sent Lanai! Orice ‘Area alt aia Sub. Cron Tw cry Dae Sue) nen tren 1 ities tr Conmunicnion 9 Telephone Number & Xs Cony cate Areas Cade Mebeprer ays ols s[ elo ie 7 Erato 10 situs ot apticane sam ara (een nave corsa Fannerp om Ey eosten ot arene rte Local Aart Artist utscl Poors [] Linde usb Parercio “1 Regatration Nomber fr ei ascot hot ae SEATS I 12 In cawe of 2 person, who is required to asd FoF the Enrolment ID ‘n vot 09 per section 128 AA Fuses meron yor MOHAAR rer (alata) [ WAACHAAR number ine Sd lass marion th bin BO Asdis aesio Name per ACH AAS er ao fer EN oP | Hf c 13. Source tincome ‘Salary Income ten Bushes Profesion —Bireastratesson cece [_[ ] {ForCode-Reterineructons] |_| Income tom Other sources Income frre Howse property . SNS NIETO LL Peas Ful name, add'eoe of fre Repesertztve Ansenses, who essesstle under Ee come Tax Act respect othe pean, hase paieulays have ‘been ven inthe conn 1-13. Fo panded ran oe cer wo rH aaa Flt Room / Door as No. Name ef Premises /Bulcng / Vilage Read Stes /LanaPoet Orion ‘tea! Leaky Taha Sb Cvion Tow | Cap tit Bate / Uren Terry Peed 4 = P cat (rye have erica = 1 root of deny 2 pot a adress and as ot of dae fh, Tie, Fafa ot mandtoy cated curenso be eve we aepbatte] aonesure A Amerure& AmeruteC ae te used vrarevr scab Ww we EHANT UB3ZD SLIT], tne agncat. inte caper t nS ee me Seer) 657A ACS . DOM wry yy — tite: FaySTT By} nethant nate boo ‘Government of Assam — @ SRUEDUNOERSECHONAa2 ‘Thiel to certly aha Soe/Smefeumart CLANS BORDOLOT Bacteria BANGAL poen, V0, fe oF se. BOR DOL OT shat Date of wicth a ttm RATA ABORT ng SHU REAN Ding oe MORI GAN, domicile of State Assam, ‘AS Der my knowledge his/Ner moral chamseters good. | with hi/ruceees i te, Wed “edeang poder. E Pirs Kalpena Polas Pattee Of sgrmeany Hla Sniponn Be Ward tember Oe peott, fottes..Zhux bu ndha geenpan eae: Prone " me. Vo

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