Application Number: U-N005165532

Application Number Bar Code Payment Reference: WDBS0876584944 Inward Number Bar Code
Payment Date: 2022-01-31 22:03:42.0 Rs.106.90/-
Application Source: UTIITSL WEB-SITE Application Date: 31/01/2022
User Id: INTERNET USER User Name: INTERNET USER
PAN CARD MODE : Both physical PAN and e-PAN Card Application Mode : Digital Application (e-KYC)

P T N W 2 1 1

eKYC-Application

✘
K U M A R
P A P P U

P A P P U K U M A R

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Whether mother is a single parent and you wish to apply for PAN by furnishing the name of your mother only? Yes No ✘ (please tick as applicable)
If yes, please fill in mother’s name in the appropriate space provided below.
Fathers’s Name (Mandatory except where mother is a single parent and PAN is applied by furnishing the name of mother only)
K U M A R
P I N T U

Mothers’s Name (optional except where mother is a single parent and PAN is applied by furnishing the name of mother only)
D E V I
A S H A

(In case no option is provided then PAN card will be issued with father’s name except where mother is a single parent and you wish to apply for
PAN by furnishing name of the mother only) ✘

S / O : P I N T U R A Y K A R M O P U R

R A M D A U L I V A I S H A L I

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 ✘

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Mithleshkumarkumar82745@gmail.com

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P A P P U K U M A R

✘
R A I
M U N N A

0
K A R M O P U R
Z A F R A B A D H

V A I S H A L I
B I H A R 8 4 4 5 0 3

AADHAAR Card issued by UIDAI (In AADHAAR Card issued by UIDAI (In Copy)
Copy)
AADHAAR Card issued by UIDAI (In Copy)

MUNNA RAI REPRESENTATIVE ASSESSEE

HAJIPUR
eKYC-Application

3 1 0 1 2 0 2 2
 Enrolment No.: XXXX/XXXXX/XXXXX
To
Download Date:31/01/2022

Pappu Kumar
S/O: Pintu Ray
karmopur
Ramdauli
Vaishali Bihar-844503
Issue Date:18/03/2018

Signature Not Verified

Digitally signed by DS
UNIQUE IDENTIFICATION
AUTHORITY OF INDIA 04
Date: 2022.01.31 22:04:24
IST

4445 0635 1566

Pappu Kumar Address:

Download Date:31/01/2022

S/O: Pintu Ray, karmopur, Ramdauli,

ज म ित थ/DOB: 10/02/1999
Issue Date:18/03/2018

Vaishali,
पु ष/ MALE Bihar, 844503

4445 0635 1566 4445 0635 1566

Signature Not
Verified
Signed by :PAPPU KUMAR
Date : 31/01/2022 22:11:04
Reason : eSign Service
Location : India