Under section 139A of the Income Tax Act, 1961
To avoid mistake (s), please follow the accompanying instructions and examples before filling up the form
Assessing officer (AO code)
Sign/ leftTumb impression across this photo
Area code
AO type
Range code
AO No.
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 to be mentioned as appearing in proof of identity/address documents: initials are not permitted)
Please select title, as applicable
Shri
Smt.
Kumari
M/s
Last Name / Surname First Name Middle Name
2 Abbreviation of the above name, as you would like it, to be printed on the PAN card
3 Have you ever been known by any other name?
If yes, please give that other name
Please select title, as applicable
Yes
No
(Please tick as applicable)
Shri
Smt.
Kumari
M/s
Last Name / Surname First Name Middle Name
4 Gender (for Individual applicants only)
Male
Female
(Please tick as applicable)
5 Date of Birth/Incorporation/Agreement/Partnership or Trust Deed/ Formation of Body of individuals or Association of Persons
Day Month Year
6 Father's Name (Only 'Individual' applicants: Even married women should fill in father's name only)
Last Name / Surname First Name Middle Name
7 Address Residence 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 Pincode / Zip code Country Name
Office Address Name of office
Flat/Room/ Door / Block No. Name of Premises/ Building/ Village Road/Street/ Lane/Post Office Area / Locality / Taluka/ Sub‐ Division Town / City /