108.2019 tps: muti! com/paneniineservices/acdPanAppFom.action 3 Date: 03/10/2019 VilelD:- MPK20160720014597 Application Number: A024131437 ‘Coupon Number: A024131437 [Both e-PAN and [physical PAN Card ‘Assessing Officer(AO Code) ‘Area Code. ‘AO Type Range Code —_ ‘AO NO. L BPL L Ww a 1 ffs arts pan epance ser ae ep [rite SHRI bast Name:- PRASAD First Name: KOM [> Abiroviaton ofthe above name, as you would Ike it KOML PRASAD cs [Have you been known by any other name? N iz feast Name= [Middle Names First Name = la. Gondr= MALE See eae ' Date of Birth Incorporation/Agreement/Partnership or Trust DeediFormation of Body) ee iduals/Association of Persons:= 1101/1988 Details of Parents (applicable only for individual pplicants), |pwinctner mothers a le parents and you wish To apply for PAN by furnishing the name of your mother only? yo I. Fathers Name. |Last Name KISHOR [Mice Narn The name of either father or mother which you may : nse rm on Pn cae’ prrmens name [First Namo:-_ RAM L eS ang | FatiDooriBiock No.- —_ ie aaa ~ |_ Name of Premises/Building/Vilage RAMIMALYA |[_ Road/StreetiLaneiPost Office:- “JPost BiUAWAR | Avealtocality/Tatuka/Sub-Division:- [TEHSIL BWUAWAR atari Sere ay” __pmcode:-_arsaos [countrys INDIA I~ Otficiat Address:- ‘I hips wm mutts com panonineservices/addPantgpForm action2019 htps:itwwww myutits com/panonineservices/addPanAppFom action! Office Name j FiauDoorfBlock No. [_Name of Premises/Bullding Vilage | RoadiStreetLane/Post Ofice:- a Area/Locality/Taluka/Sub-Division:- TowniCityiDistriet= tae/Union Teri “Adress for Communication: __eountry:- [p. Teephone Number & Ema Detais = ] (Country ‘fF — Piso __ | ypcoanam@amait.com ho. Stats ofthe Apaieant: [11. Registration Number(for c irMS.LLP's ete):= ] 2. In case of a person, who is required to quote Aadhaar Number! the {Enrolment 10 of Aadhaar Application form as por section 139AA pieees Menton your AADHAAR number(f Ea wiisnledas it Aadhaar number is not alloted, please mention tho enrolment 1D of Aadhaar application form =: ‘As por AADHAAR letercard or as per the [kom paagap ‘nrolment iD of Aadhaar application form [13-Source of income SALARIED Capital Gains Income from BusinessiProtession JE trcome from Other sources Income from House property No income 8. Ful Name, address ofthe Representative Assesses, who son, whose particulars have been given in colmns 1 10 13 isSossable under the Income Tax Act in respect of the [Middle Name:- | lavDoorBiock Wo. ame of Promises/Bulling/ Vag RosurStrecuaneiPest Offi [Area ocanty/Talika/Sub-Division™= i ‘owniGityDistct: [StateUnion Tereiory= IN Code 5. We have enclosed AADHAAR Card issued by UIDAI (in Copy) as Proof of aentl [VIDA (In Copy) _as Proof of Address and _AADHAAR Card issued by UIDAI (In Copy) as Prost of DOG ['6. Wo KOML PRASAD ty of HIMSELFIHERSELF do hereby declare that what is stated [pbove is true to the best of my/our information and belie. ‘AADHAAR Gard issued by a comes : cima 03-[e-2.219, Ont Fl = {Signature/Left thumb impression of the) Place Dat a ps iw myitits comppanonineservicesiaddPanappFon actond : 2TIS HINT eit BLT | Enrollment No 1085/90485/24833 Boas yore S10 Ran Kisho Sjamar awar Chater | ~*~ s a Ret 2253/ 22V/216385/216955 1° | {000 APT 'SE279249847=7 i yes wag Sag / Your Aadhaar No. : 7971 8224 9252 7971 8224 9252 ror - WMH arent EF wiftrers