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Request For New PAN Card Or/ And Changes Or Correction in PAN Data
Signature/ Left thumb impression across this photo
Permanent Account Number (PAN)
Please read Instructions 'h' & 'i' for selecting boxes on left margin of this form.
1 Full Name (Full expanded name to be mentioned as appearing in proof of identity/address documents: initials are not permitted)
Please select title,
Last Name / Surname
as applicable
Shri
Smt
Kumari
M/s
First Name Middle Name
Name you would like it printed on the PAN card
2 Father's Name (Only 'Individual' applicants: Even married women should fill in father's name only)
Last Name / Surname First Name Middle Name
3 Date of Birth/Incorporation/Agreement/Partnership/Trust Deed/ Formation of Body of individuals or Association of Persons
Day Month Year
4 Gender (for 'Individual' applicant only) 5 Photo Mismatch 6 Signature Mismatch 7 Address for Communication
Name of office (to be filled only in case of office address) Flat/Room/ Door / Block No. Name of Premises/ Building/ Village Road/Street/ Lane/Post Office Area / Locality / Taluka/ Sub- Division Town / City / District State / Union Territory
Male
Female
(Please tick as applicable)
Residence
Office
(Please tick as applicable)
Pincode / Zip code
Country Name
8 If you desire to update your other address also, give required details In additional sheet. 9 Telephone Number & Email ID details
Country code Email ID Area/STD Code Telephone / Mobile number
10 AADHAAR number (if allotted) 11 Mention other Permanent Account Numbers (PANs) inadvertently allotted to you
PAN 1 PAN 2
12 Verification
PAN 3 PAN 4
I/We , the applicant, in the capacity of do hereby declare that what is stated above is true to the best of my/our information and belief. I/We have enclosed Place D Date D M M Y Y Y Y Signature / Left Thumb Impression of Applicant (inside the box) (number of documents) in support of proposed
Signature/ Left thumb impression across this photo
Permanent Account Number (PAN)
Please read Instructions 'h' & 'i' for selecting boxes on left margin of this form.
1 Full Name (Full expanded name to be mentioned as appearing in proof of identity/address documents: initials are not permitted)
Please select title,
Last Name / Surname
as applicable
Shri
Smt
Kumari
M/s
First Name Middle Name
Name you would like it printed on the PAN card
2 Father's Name (Only 'Individual' applicants: Even married women should fill in father's name only)
Last Name / Surname First Name Middle Name
3 Date of Birth/Incorporation/Agreement/Partnership/Trust Deed/ Formation of Body of individuals or Association of Persons
Day Month Year
4 Gender (for 'Individual' applicant only) 5 Photo Mismatch 6 Signature Mismatch 7 Address for Communication
Name of office (to be filled only in case of office address) Flat/Room/ Door / Block No. Name of Premises/ Building/ Village Road/Street/ Lane/Post Office Area / Locality / Taluka/ Sub- Division Town / City / District State / Union Territory
Male
Female
(Please tick as applicable)
Residence
Office
(Please tick as applicable)
Pincode / Zip code
Country Name
8 If you desire to update your other address also, give required details In additional sheet. 9 Telephone Number & Email ID details
Country code Email ID Area/STD Code Telephone / Mobile number
10 AADHAAR number (if allotted) 11 Mention other Permanent Account Numbers (PANs) inadvertently allotted to you
PAN 1 PAN 2
12 Verification
PAN 3 PAN 4
I/We , the applicant, in the capacity of do hereby declare that what is stated above is true to the best of my/our information and belief. I/We have enclosed Place D Date D M M Y Y Y Y Signature / Left Thumb Impression of Applicant (inside the box) (number of documents) in support of proposed