‘Application Number/A096056642_ TUNDUVIUTMIID > r: eszzszercnee vores — ASSSOS SS 4= | Payment Date: 04/07/2024 Rs.107.00/- |Application Source: [EWALLET - A- CSC E GOVERNANCE SERVICES INDIA LIMITED JApplication Date:|04/07/2024 5 ta-[246 132730019 ]user Name-[246132730019 J PAN CARD MODE : Both phy us Application for Allotment of Permanent Account Number [in the case of Indian Citizens! Indian Compar ‘Assessing officer (AO code) ‘Area code ‘AO type Range code AO Na pil[elil[w ale 9 [3 Sir, Ie hereby request that a Permanent Account Number be alloted to metus. Ine give below necessary particulars 1 Full Name (Full expanded name to be mentioned as appearing in proof of identtyladdress documents: initials are not permitted) Please select ttle, [y’]as applicable sii [_]ome—[w]kumari [Jaws Last Name / Surname BIA|M|R/A | Fst Name 1 s/H|M/E/e/T ‘Middle Name K/AUIR 2. Abbreviations of the above namo, as you would ik it, to be printed on the PAN card ViS/HMJE/ET| |K/A|UIR| |B A|M|R/A 3. Have you ever been known by any othor name? vos [Y]no (please tick as applicable) tye plese ae hatter ae Please select tite, |} as applicable [shri jst. kumar sais Lost Name /Sumame FtstName Mile Name 4 Gender (or Individual applicants only) mate [7] Femate Transgender (please tick as applicable) Day Month Year 5 Date of Birthincorporation Agreement/Partnership of Test Deed! Formation of Boey of individuals or association of Persons. 2[6| [o[5] [2[o|o[5) {Details of Parents (aplenbie only fr individual applicants), {eter motors angie parent ac you wsh 0 apy for PAN by urishing he name of yourmeihor ol? Yes[_] Now] (aso ck as appicaba Ty. pease tin motors ame nthe appropriate spece proved baton Father's Name (Mandatory except where mother i a single parent and PAN is apoied by furnishing the name of mother ony) Last Name Surname s|1|N|G|H First Name olMikfaiR] |] | il Miseie Name I [Motners’s Name (optional except where mother is a single parent and PAN is applied by furnishing the name of mother only) Last Name f Summame Fst Name ladle Neme I I I Selec the ram of ther father ormher WEN may Te Be wed on PAN a ao {rrease na opon provided en PAI card we sued wh hers nar except wore moter a single parent rd you wish 0 ppt for Patty unig ame ftw oto) [7 7 Address Residence Address Fiat Rom Doo Block No Name of Promises /uiing Vilage Fond! Steet LanePost Ofice fea Local Tata Su Dison Town Cty Dstt State/ Union Teton, Pincode [2p DELHI 1/1 |0\0 fice Aarons | Nano otefice Flat Room / Door | Block No, | Name of Promises Building Vilage | oad Sst LanlPet Ofics Father's name Mother's Name enw wd acaneae) O[UISTE Ljole Ky IN) E\E|TIA il AIN[DUH [1] A >[2|=|>1 [2|<|o| 5} (mlololajx| =|z\0) 8 F\‘Area Locality (Taka Sub- Oision ‘Town ity District [ 8 Address for Communication ¥] Residenc Doottice (Ploase tick as applicable) 8 Telophone Number & Email details County code __Area/STD Code ‘Telephone / Mobile number oft @][8[2[o[2|7]9|2 [8 Email\O [brothersinternetcafe1;@gmail.com 10 Status of applicant Plaase solect status, [V/]as applicable eovernment [Z)incivaver — _Jindu undivided tamty [_Jcompany Partnership Fim [association of Persons [ors Eso ctntiuos —— Eocataurorty Jat! rica Persons [Jute tity Parnes 11, Registration Number (for company, firms, LLPS etc) 121m Case ofa person, who is required to quote Aadhaar numberThe Enrolment ID of Aachear application form as per section 139AA Please mention your ANDHAAR numbar (totes) [4 | 5] 3] 8] [8] 2] 3] 5] [0] 7] 5] 5 \WAADHAAR numbers et aloe, please mention the enromentD of Aachaar appiation frm [Namo as per AADHAAR letericard oF as par the Enrolment ID of Aadhear application form T/S|H[M[ Ele] Tt] [K]A| UR] |B[Al MRI Al 13. Source of Income Please select, [¥/] as applicable CL satay Income from House property DD no income LL capital ceins LL income trom Business Pression Businessrofession code [_[_] (For Code: Reterinstuctons} [¥/] income from Other sources ‘4 Representative Assesseo (RA) Full name, address of the Representative Assessee, whois assessible under been given inthe column 1-13, Full Namo (Full expanded nam initials are not permitted) the Income Tax Actin respect ofthe person, whose particulars have Please select tte, V/] as applicable kumar hws sia sme Lost Name /Suame I Fit Nae il Name Address Flat / Room / Door / Block No. Name of Premises / Building / Vilage Road / Street /Lane/Post Office ‘Area / Locality Talukal Sub- Division Town / city / District State / Union Tetory Pincode 15 Documents submitted as Proof of Identity (PO), Proof of Address (POA) and Proof of Date of Birth (0B) 23 prof otwentty, [AADHAAR Card issued by UIDAT | | AADHAAR Card issued by We have enclosed 8 proof of address and [AADHAAR Card issued by UIDAT | as poof of date of bith [Prease refer to the instructions (as specified in Rule 114 of 1. Rules, 1962) for list of mandatory certified documents to be submited as applicable} [Annexure A, Annexure B & Annexure C are to be used wherever applicable) |ISHMEET KAUR BAMRA the capacity of, 16 wwe| the applicant, in 4 hereby declare that what is stated above is ue tothe best of myfour information and belie. Place [DELHI pomM yyy vy Date of4Jo[7 [2 [oT 214 Signature / Left Thumb Impression of Applicant inside the box)