Acknowledgement for request for new PAN card (Form 49A)

ACKNOWLEDGEMENT NUMBER:

881030136725852

Citizen of India Y

Affix recent
photograph
(3.5cm x 2.5cm)

Category

Individual

Name

Smt. JAYALAKSHMI POTNURI

Affix recent
photograph
(3.5cm x 2.5cm)

Name to be
JAYALAKSHMI POTNURI
printed on card
Father's Name Shri MUNEESWARAO CHIDAGAM
Date of Birth
Residential
Address

Signature/ Left Thumb

Impression across this
photo

18-10-1963
10-24
OPP POST OFFICE
KONA VARI STREET
GOKAVARAM
EAST GODAVARI - 533286
Andhra Pradesh

Office Address
Address for
RESIDENTIAL
Communication
Telephone No.

91 9866494481

Email ID

DNRAO65@GMAIL.COM

AADHAAR No. 2076 8571 0896

Payment Mode

Net Banking: Your Payment of ` 106 against transaction number 400-2642953 has been successfully processed.

I/We, potnuri jayalakshmi the applicant, do hereby declare that what is stated above is true to the best of my/our information and belief.
The following documents are enclosed as:
Proof of Identity: Copy of Elector's photo identity card
Proof of Address: Copy of Elector's photo identity card
Proof of Date of birth: Copy of Photo identity card issued by the Central Government or State Government or Public Sector Undertakingi
Proof of Identity of representative assessee:
Proof of Address of representative assessee:

Any other document:

Date: 31-10-2015

Service Tax Code (Registration Number): AAACN2082NST001

Service Tax Registration Category: BUSINESS AUXILIARY SERVICES
CIN U72900MH1995PLC095642

(PLEASE READ INSTRUCTIONS GIVEN ON NEXT PAGE)

Signature/ Left Thumb Impression of Applicant

(inside the box without touching the sides and in BLACK INK ONLY)

Instructions:
1. 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.
2 Save and print this acknowledgement.
3. Application fee and mode of payment: Payment favouring 'NSDL-PAN' can be made as follows:
Sr. No.

Address for
Communication

Amount payable
( )

Indian

106

Credit card / Debit card/ Net Banking / Demand Draft (DD) payable at Mumbai.

Foreign

985

Credit card / Debit card / Demand Draft (DD) payable at Mumbai

Mode of payment

Please mention name of applicant and acknowledgement number on the reverse of DD.
4 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.
5 Superscribe the envelope with 'APPLICATION FOR PAN - Acknowledgement Number' (e.g. 'APPLICATION FOR PAN 881010100000973').
6 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.
7 Your acknowledgement, Demand Draft if any, and proofs, should reach NSDL within 15 days from the date of online application.
8 Application will be processed only on receipt of relevant proofs and realisation of payment.
9 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.