U-Q008200302

3068114429598226 / PY0092601748
09/03/2023 11:44:01
D:WB061701207
UserI Amount
: Rs.:106.90/- 09/03/2023
UserName: Appl
icat
i ce:EWALLET
onSour - A - CSC E GOVERNANCE SERV
dMode:Both physical PAN and e-PAN Card
PANCar Appl
icat
ionMode: Digital Application

D C K P P 0 7 6 8 R

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P U R K A I T
C H A N D R A L E K H A

C H A N D R A L E K H A P U R K A I T

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M O N D A L
L A K S H M A N
C H A N D R A

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C / O C H I N M A Y P U R K A I T
M A N K H A N D A S O U T H 2 4

P A R G A N A S

WEST BENGAL 7 4 3 3 6 8 INDIA

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saraswateetechnology@gmail.com
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C H A N D R A L E K H A P U R K A I T
CHANDRALEKHA PURKAIT HIMSELF/HERSELF

1
KANKJOLE PASHCHIM

0 9 0 3 2 0 2 3
 Enrolment No.: XXXX/XXXXX/XXXXX
To
Download Date:09/03/2023

Chandralekha Purkait
C/O Chinmay Purkait
Mankhanda
South 24 Parganas West Bengal-743368
Issue Date:20/01/2014

Signature Not Verified

Digitally signed by DS
UNIQUE IDENTIFICATION
AUTHORITY OF INDIA 04
Date: 2023.03.09 11:45:14
IST

8584 7536 6702

Chandralekha Purkait Address:

Download Date:09/03/2023

C/O Chinmay Purkait, Mankhanda, South

Date of Birth/DOB: 23/08/1960
Issue Date:20/01/2014

24 Parganas,
Female/ FEMALE West Bengal, 743368

8584 7536 6702 8584 7536 6702

 Consent Form Aadhaar holders

Biometric and/or OTP based eKYC and Aadhaar Authentication

PAN/ApplicationNo.:
Q008200302

Name as per PAN card:760255072247

CHANDRALEKHA PURKAIT

Aadhaar number: xxxx-xxxx-6702

Name as per Aadhaarcard: CHANDRALEKHA PURKAIT

Declaration:

I do hereby confirm that the Aadhaar given above has been issued to me by UIDAI. As a
part of process, the Aadhaar/eKYC data may be used only for the requirement of PAN
allotment.

I state that I do not have any objection in authenticating myself with Aadhaar based
authentication system and I hereby provide my consent to use my Aadhaar number,
Biometric and/or One Time Password (OTP) data for authentication for the purpose of
fulfilling the requirement under PAN process.

I understand that the Biometric and/or OTP provided for Aadhaar authentication /
eKYC data shall be used only for authenticating my identity through the Aadhaar
Authentication system for the purpose of only PAN allotment process.

This is further acknowledged that while submitting through Change Request Form in
PAN data. If in case, Aadhaar is not linked with PAN then through this process
Aadhaar will not be linked with PAN i.e. will be used for authentication /eKYC
purpose only.

I understand that complete security and confidentiality shall be ensured for my personal
identity data provided for the purpose of Aadhaar based authentication.

Date 09/03/2023 Signature / Thumb Impression

Signature Not
Verified
Signed by :CHANDRALEKHA
PURKAIT
Date : 09/03/2023 11:51:50
Reason : eSign Service
Location : India