Affix recent

photograph
(3.5cm x 2.5cm)
Affix recent
photograph
(3.5cm x 2.5cm)
Signature/ Left Thumb
Impression across this
photo
ACKNOWLEDGEMENT NUMBER:
Citizen of India
Category
Name to be
printed on card
Father's Name
Name
Office Address
Address for
Communication
Residential
Address
Date of Birth
Telephone No.
AADHAAR No.
Email ID
Y
Individual
Shri PRASHANT KUMAR SINGH
PRASHANT KUMAR SINGH
Shri CHANDRA SHEKHAR SINGH
28-01-1994
416
BLOCK-C
11/2
MUKANDPUR
NORTH WEST DELHI - 110042
Delhi
881020124769595
ME11727.SBIT@GMAIL.COM
91 9958171173
RESIDENTIAL
Payment Mode
Credit Card: Your Payment of ` 105 against transaction number 400-1499268 has been successfully processed.
The following documents are enclosed as:
Proof of Identity:
Proof of Address:
Proof of Identity of representative assessee:
Proof of Address of representative assessee:
Any other document:
Date:
Copy of driving license
Copy of driving license
14-08-2014
Signature/ Left Thumb Impression of Applicant
(inside the box without touching the sides and in BLACK INK ONLY)
Service Tax Code (Registration Number): AAACN2082NST001
Service Tax Registration Category: BUSINESS AUXILIARY SERVICES
I/We, Prashant kumar singh the applicant, do hereby declare that what is stated above is true to the best of my/our information and belief.
Proof of Date of birth: Copy of Matriculation certificate
CIN U72900MH1995PLC095642
(PLEASE READ INSTRUCTIONS GIVEN ON NEXT PAGE)
Acknowledgement for request for new PAN card (Form 49A)
Instructions:
The acknowledgement number above is your unique reference number for PAN application. Kindly quote this number for tracking
the status of your PAN application on https://tin-nsdl.com or any queries relating thereto.
Save and print this acknowledgement.
Application fee and mode of payment: Payment favouring 'NSDL-PAN' can be made as follows:
Sr. No.
Address for
Communication
Amount payable
( )
Mode of payment
1 Indian 105
Credit card / Debit card/ Net Banking / Demand Draft (DD) payable at Mumbai/Cheque to be
deposited in any HDFC bank branch across the country (except Dahej).
2 Foreign 971 Credit card / Debit card / Demand Draft (DD) payable at Mumbai
Please mention name of applicant and acknowledgement number on the reverse of cheque/DD.
Individual applicants affix your recent colour photograph (3.5 cm x 2.5 cm), sign the acknowledgement (inside the box provided
without touching the sides and in BLACK INK only) and enclose a Demand Draft (DD), if any, alongwith Proof of Identity, Proof
of Address and Proof of Date of Birth as specified in the application form.
Superscribe the envelope with 'APPLICATION FOR PAN - Acknowledgement Number' (e.g. 'APPLICATION FOR PAN -
881010100000973').
Send the documents as specified in point no. 4 above to Income Tax PAN Services Unit, NSDL e-Governance Infrastructure
Limited, 5th floor, Mantri Sterling, Plot No. 341, Survey No. 997/8, Model Colony, Near Deep Bungalow Chowk, Pune -
411016 Tel: 020-27218080; Fax: 020-27218081.
Your acknowledgement, Demand Draft if any, and proofs, should reach NSDL within 15 days from the date of online application.
Application will be processed only on receipt of relevant proofs and realisation of payment.
PAN card will be dispatched only to the communication address provided in your PAN application. Wherever the
Representative Assessee (RA) details ( item no.14 in Form 49A ) are mentioned in the application, PAN card will be dispatched to
the RA's address.
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