Number U-Q014870567

|Application NumberA095375372
PYO133613958
/
Reference:417711 1723777456
Payment |25/06/2024 Rs.107.00/ |Application Date:25/06/2024
JPayment Date: INDIALIMITED
GOVERNANCE SERVICES
EWALLET-A-CSC E
|ApplicationSource: JUser Name:275437250012
User ld:275437250012
e-PAN Card
Application Mode:Physical Applic
Both physical PAN and
|PAN CARD MODE: Form No. 49A
Account Number
of Permanent
Application for Allotment incorporated in Indial
Citizens/ Indian Companies/ Entities
[tn the case of Indian
Unincorporated entities formed
in India)
See Rule 114 the orm
examples before 6ing up
the crompanying instructions and
mstakes pteae foliow
To avvd

code)
Assessing officer (AO
Range code AO No..
Area code AO type
5 5 4
P R W
A

allotted to melus.
Account Numtber be Sgnature'Left Thumb Impression
hetbby reguest that a Permanent
Sir. iWe
documents: initials are not permitted)
necessary particulars of identityladdress
IWe give below appearing in proof
name to be mentioned as
Full Name (Full expanded Smt. Kumari M/s

Please select titleVas

applicable VShri
sHA NKA RA|AH
Last Name / Surname
SUNKARI|
First Name

Middie Name
be printed on the PAN card
as you would like it, to
2 Abbreviations of the above name.
SHA NKA RA| AH
SUN KARI
(please tick as applicable)
Yes NO
by any other name?
3 Have you ever been known
yes, please give that other
name
M/s
H
applicable Shri Smt. Kumari
Piease select title.as
Last Name /Surname
First Nane

Middie Name Transgender (please tick as applicable)

Female
4 Gender (for Individual applicants only)
[VMale Year
Day Month
Birth/Incorporation/Agreement/Partnership or Trust Deed/
o1 01 |1963
5 Date of association of Persons
Formation of Body of individuals or
individual applicants), (please tick as applicabie)
6 Details of Parents (applicable only for
furnishing the
wish to apply for PAN by name of your mother only? YesNo
Whether mother is a single parent and you
appropriate space provided below. only)
If yes,please fill in mother's name in the by furnishing the name of mother
mother is a single parent and PAN is applied
Fathers's Name (Mandatory except where |LINGA M
Last Name / Surname BAL
SUN KARII
First Name
Middle Name applied by furnishing the name of mother only)
nother is a single parent and PAN is
Mothers's Name (optional except where
Last Name / Surname

First Narne
Middie Name
may like to be printed on PAN card (oced one only
Select the name of either father or mother which you mother is a single parent and you Wish to apply for
be issued with father's name except where
(In case no option is provided then PAN card will
PAN by funishing name of the mother only)Father's name Mother's Name (Please tick as applicable)

7 Address
Residence Address
1-9 9
Flat /Room / Door / Block No. PE N | M ||LLA
Name of Prernises /Building /Village
P E N | M |LLA
Road / Street / Lane/Post Office
Area / Locality / Talukal Sub- Division UPP|UNUNTH ALA
Town /City / District MAHABUB NAGAR Country Name
Pincode/Zip code
State /Union Territory
TE L A N GAN A 509376 IND | A
Office Address
Nane of office
Flat / Room / Door / Block No

Name of Premises /Bilding /Village

Road/ Street / Lane/Post Office
 KS..

|Applicati
|Appicocaity / Taluka Sub- Division
Cty /District
/And

(Please tick as applicable)

Acddress for Communication
Residence office
9 Tetephone Number & Email ID details Telephone / Mobile number
Country code Area/STD Code
154254|2936
Emal D kO0110982 @gmail.com
10 Status of applicant Government
Piease seiect satus, as applicable
Association of Persons
Company Partnership Fitm
Vindividual Hindu undivided family
Linited Liability Partnership
Local Authoriy Artificial Juridical Persons
Trusts Bocy of Individuals
11 Registration Number (for company, firms, LLPs etc.)
139AA
Aadhaar application form as per section
quote Aadhaar number/The Enrolment ID of
12 in Case of a person, who is required to
5o7 7 1 5
Please mention your AADHAAR number (f allotted)7427|16
enrolment ID of Aadhaar application form
the
if AADHAAR number is not allotted. please mention

Enroiment ID of Aadhaar application form

Name as per AADHAAR letter/card or as per the
SUN KA R sHANKA RA |A H

Piease select, as applicabie

13 Source of fncome
Capital Gains
No income
Salary income from House property
Business/Profession code IFor Code: Refer instructions] Income from Other sources
Income from Business / Profession
14 Representative Assessee (RA)
the Income Tax Act in respect of the person, whose particulars have
Full name, address of the Representative Assessee, who is assessible under
been given in the column 1-13
Full Name (Fuil expanded name : initials are not permitted)
Please select titleas applicable VShri JSmt.KumaniMs
Last Name / Surname BAL L I NGA M
UN K A R
First Name

Middie Narne
Address

Flat / Room /Door / Block No. 1 9

Name of Premises /Building / Vilage EN M L|A

Road / Street / Lane/Post Office EN M LLA

Area l Locality / Talukal Sub- Division PU N UNT H A L

Town /City / District M A H A BUB NA GAR

State /Union Territory TE L A N GA NA 5 0 93 7 Pincode

15Documents subrmitted as Proof of ldentity (PO), Proofof Address (POA) and Proof of Date of Birth (DOB)
IWe have enciosed AADHAAR Card issued byas proof of identity, AADHAAR Card issued by UIDAL
as proof o address and AADHAAR Card issued byUIDAI as proof of date of birth.

[Please reler to the instructions (as specified in Rule 114 of I.T. Rules, 1962) for list of mandatory certified documents to be submitted as applicable)
(Annexure A, Annexure B&Annexure C are to be used wherever applicable]
16 IMe SUNKARI SHANKARAIAH the applicant, in the capacity of HIMSELF/HERSELF
do hereby declare that what is stated above is true to the best of my/our informalion and belief.

Place: PENIMILLA

DD M M Y Y Y Y
Date 25 062o24
Signature / Left Thumb Impression of Applicant (inside the box)
an12 A

AADHAAR
3/TTR Govemment of India

áárooa» /INFORMATION

Government of India
'eooeres a) mAadhaar
do vr5 OR 6airs G30ro dor www.uidai.gov. in
Unique ldentification Authority of India
Ss5/ Enrolment No.: 2081/11066/48462
To

Sunkari Shankaraiah
S/O: Sunkan Bal Lingam,
1-99
penimila.
penimilia
VTC. Penmilla,
PO: Penimilla.
Sub District: Uppununthala,
District: Mahabubnagar.
DO8
State: Telangana, Aadhaar is proof of identity, not of citizenship or date of birth (DOB).
specified in
PIN Code: 509376. is based on information supported by proof of DOB document
Mobile. 9542542936 requlations, submitted byAadhaar number holder.
This Aadhaar letter should be verified through either online
authentication by UIDAI-appointed authentication agency or QR code
available in
scanning using mAadhaar or Aadhaar QR SCanner app
app stores or using secure QR code reader app available on
www.uidai.gov.in.
Aadhaar is unique and secure.
D Documents to support identity and address should be updated in
Signatureyalid Aadhaar after every 10 years fromn date of enrolment for Aadhaar.
11 1C21
Aadhaar helps yOU avail of various Government and Non
Government benefits/services.
Keep your mobile number and email id updated in Aadhaar.
e s 5 J o /Your Aadhaar No. : Download mAadhaar app to avail of Aadhaar services.
7427 1650 7715 Use the feature of Lock/Unlock Aadhaar/biometrics to ensure
VID:9193 9528 0320 6686 security when not using Aadhaar/biometrics.
Entities seeking Aadhaar are obligated to seek consent.

Government of lndia Unique ldentification Authority of india

issued
o.
201n0i2013
s/O: sso`8 er Ooño,1-99, 3aag, JINN,
Sunkari Shankaraiah
Ds /DOB: 01/01/1963 RJvore -509376
Joya MALE Address:
s/o: Sunkari Bal Lingam, 1-99, penimilla,
õpenimilla, Penmilla, PO: Penimilla, DIST:
Mahabubnagar,
STelangana -509376
Aadhaar is proof of identity, not of citizenship
or date of birth. It should be used with verification (online
authentication, or scanning of QR code / offine XML).

7427 1650 7715

7427 1650 7715 VID:9193 9528 0320 6686
| heip @uidai.yov.in | GD www.uidai.gov.ien