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