Pan

Form No. 49A Form No. ITS 49A Application for Allotment of Permanent Account Number Under Section 139A of the Income Tax Act, 1961 Fields marked with * (asterisk) are mandatory. . To avoid mistake(s), please refer guidelines and instructions . *If you are a Defence Personnel select the To, The Assessing Officer

appropriate category Air Force Other

Ward/Circle

Individuals

Range

* Area * AO Code Type

Army

Navy

Don`t know AO details? For Non International Taxation AO details Click here For International Taxation AO details Click here * Range * AO Number Code

Commissioner Sir, I/We hereby request that a permanent account number be allotted to me/us. I/We give below necessary particulars: * 1. Full Name(Full expanded name: initials are not permitted) Title Shri Smt. Last Name/Surname

Kumari

M/s First Name

Middle Nam

* 2. Name you would like printed on the card

3. Have you ever been known by any other name? Yes No If yes, please give that other name (Full expanded name: initials are not permitted) Title Shri Smt. Last Name/Surname

Kumari

M/s First Name

* 4. Father's Name (Even married women should give father's name only) Last Name/Surname First Name * 5. Address (R) Residential Address Flat/Door/Block No. Name of Premises/Building/Village Road/Street/Lane/Post Office Area/Locality/Taluka/Sub-Division

Middle Nam

Middle Nam

Town/City/District State/Union Territory Pin (Indicating PIN is mandatory) Country Zip (O) Office Address Name of Office Flat/Door/Block No. Name of Premises/Building/Village Road/Street/Lane/Post Office Area/Locality/Taluka/Sub-Division Town/City/District State/Union Territory Pin (Indicating PIN is mandatory) Country Zip * 6. Address for communication

Residential

In case office address is selected as comm address as well as office address is to be s

Office *7. Telephone No.

STD/ISD Code

Tel. No.

e-mail ID * 8. Sex

Male

Female

* 9. Status of the Applicant Individual (P) Hindu Undivided Family (H) Company (C)

Firm (F) Association of Persons (A) Association of Persons (Trusts) (T)

* 10. Date of DD MM Birth/Incorporation/Agreement/Partnership or Trust Deed/Formation of Body of Individuals/Association of Persons 11. Registration Number (In case of Firms, companies etc.) * 12. Whether citizen of India * 13. (a)

Yes

No

Are you a salaried employee? If yes, Government Name of the organisation where working

YYYY

Others

(b)

If you are engaged in a business/ profession, indicate nature of business or profession and the relevan

(c)

If you are not covered by (a) or (b) above, indicate sources of income, if any.

14. Full name, address of the Representative Assessee, who is assessable under the Income Tax Act in respec have been given in column 1 to 13 (Representative Assessee details to be filled only in special cases like minor, lunatic, idiot, etc., as provided u/s Title

Shri

Smt.

Kumari

M/s

Representative Assessee Category

Army

Navy

Air Force

Other Individual

Last Name/Surname

First Name

Middle Nam

Flat/Door/Block No. Name of Premises/Building/Village Road/Street/Lane/Post Office Area/Locality/Taluka/Sub-Division Town/City/District State/Union Territory Pin (Indicating PIN is mandatory) * 15. Documents enclosed I/We have enclosed

as proof of id as proof of address

Further,I/We have also enclosed

a

as proof of address of representativ I/We ,the applicant, do hereby declare that what is stated above is true to the best of my/our information and belie DD MM YYYY Verified today, the 21 -11 -2009 Other Details 1. Depository Account Details DP ID: Client ID: 2. Payment Details (select appropriate mode of payment and fill relevant details) Demand Draft/Cheque (in favour of 'NSDL - PAN' for Rs.94.00)

Demand Draft number YYYY

for Rs.94.00

dated DD

MM

drawn on Cheque number for Rs.94.00

Bank, payable at Mumbai. dated DD

drawn on Bank, location (city/town).

MM Bank, deposited at HDFC

Branch at

Credit Card (Rs.94.00)

Submit

YYYY