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applNo=G021317234&applType=R
Date: 04/07/2019
VleID:-EZEEE68C616300
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7. Address:-
Residential Address:-
Flat/Door/Block No.:- FALKA
Name of Premises/Building/Village:- CHANDWA
Road/Street/Lane/Post Office:- PIRMOKAM
Area/Locality/Taluka/Sub-Division:- RUPASPUR CHANDWA
Town/City/District:- KATIHAR State/Union Territory:- BIHAR PIN Code:- 854114 Country:- INDIA
Official Address:-
Office Name:- ABHISHEK KUMAR SINGH
Flat/Door/Block No.:- FALKA
https://www.psaonline.utiitsl.com/psaonline/panDetailsAppEntry?applNo=G021317234&applType=R 1/2
7/4/2019 https://www.psaonline.utiitsl.com/psaonline/panDetailsAppEntry?applNo=G021317234&applType=R
Name of Premises/Building/Village:- CHANDWA
Road/Street/Lane/Post Office:- PIRMOKAM
Area/Locality/Taluka/Sub-Division:- RUPASPUR CHANDWA
Town/City/District:- KATIHAR State/Union Territory:- BIHAR PIN Code:- 854114 Country:- INDIA
8. Address for Communication:- RESIDENCE
13.Source of Income
Business/Profession code:-
14. Full Name, address of the Representative Assessee, who is assessable under the Income Tax Act in respect of the
person, whose particulars have been given in colmns 1 to 13.
SMT Last Name:- KUMARI Middle Name:- First Name:- SMITA
Flat/Door/Block No.:- FALKA
Name of Premises/Building/Village:- CHANDWA
Road/Street/Lane/Post Office:- PIRMOKAM
Area/Locality/Taluka/Sub-Division:- RUPASPUR CHANDWA
Town/City/District:- KATIHAR State/Union Territory:- BIHAR PIN Code:- 854114
15. I/We have enclosed AADHAAR Card issued by UIDAI (In Copy) as Proof of Identity ,
AADHAAR Card issued by UIDAI (In Copy) as Proof of Address and AADHAAR Card issued by
UIDAI (In Copy) as Proof of DOB.
16. I/We SMITA KUMARI ,the applicant,in the capacity of HIMSELF/HERSELF do hereby declare
that what is stated above is true to the best of my/our information and belief.
Signature/Left thumb
Place Date impression of the
applicant
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